A dependent of a covered retiree (or surviving spouse) who loses coverage under another health plan will be eligible to enroll for coverage in the Plan if the following apply:
The retiree (or surviving spouse) declined coverage for his dependents when first eligible because the dependent was covered by other health insurance coverage.
The dependent lost other coverage as a result of any of the following qualifying events:
Divorce;
The dependent is no longer eligible for coverage. Loss of coverage due to nonpayment of premiums does not qualify;
The employer unit ceased to contribute toward the cost of the other health plan and it was terminated;
The dependent's COBRA continuation coverage has expired.
To enroll for coverage under these circumstances, an Application for Coverage form must be submitted within 60 days of losing coverage under the other plan and appropriate premium payments must be made. As part of the application process, proof of loss of coverage must be provided. If these requirements are met, coverage under the Plan will take effect the first day following the loss of other coverage.