D. PLAN SELECTION AND ENROLLMENT

1. Plan Selection.

Under the Plan, you may select among various benefit options, including an indemnity option or two HMO options. Refer to Section VI for general information concerning HMOs that are available under the Plan. If you do not select one of these options, you will automatically be enrolled in the Indemnity Plan. (See V.A.)

2. Open Enrollment.

You will be given the opportunity to change Plan selections during special open enrollment periods which usually occur during the month of July, with changes effective August 1st. The Plan will send open enrollment material with Plan information shortly before each open enrollment period. Be sure to enroll your Dependents when you first enroll, otherwise, subject to Special Enrollment provisions in paragraph 3, below, you may enroll your Dependents only during open enrollment. Exception: the Plan allows enrollment when your Dependent is first eligible for coverage as a result of marriage, domestic partner registration, birth or adoption of a child, or the enrollment of a dependent child over age 19 as a full-time student. All of your Dependents are covered in the same option that you choose for yourself, if they are properly enrolled in the Plan. No benefits are payable for any person who is not properly enrolled. The Board has the discretion to change or establish other open enrollment periods.

3. Special Enrollment.

If Plan benefits are available without cost to you, you will ordinarily want to enroll in the Plan, along with your spouse or Domestic Partner and other Dependents. Potentially, however, you might want to decline enrollment for an otherwise eligible family member (e.g., to avoid taxable income for covering a persons who do not meet the definition of dependent under the Internal Revenue Code). If you decline enrollment for any eligible individual who has other health insurance coverage, you may later enroll that individual in the Plan if you request enrollment within 30 days after that other coverage ends. Also, if you have a new Dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your Dependents if you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

4. Optional Supplemental Benefit for Medicare-Eligible Retirees.

Medicare-eligible Retirees and/or Dependents who have chosen to enroll in a Medicare program not offered through the Plan may elect the supplemental benefit program as described in Section VII, Supplemental Benefits, beginning here. If you are a Medicare-eligible Retiree and choose supplemental benefit coverage only, you may opt into one of the Plan’s available Medicare Risk programs (e.g., PacifiCare Secure Horizon or Kaiser Senior Advantage) but only during a Plan open enrollment period.

Please note that if you are a Medicare-eligible Retiree and choose to enroll with an outside Medicare Part D provider (covering prescription drugs), you will automatically be dis-enrolled from the Plan’s medical programs including the Indemnity Plan, PacifiCare Secure Horizon and Kaiser Senior Advantage, and your and your family’s coverage under the Plan will be limited to the dental and vision supplemental benefits. See VII. B and C.

5. Enrollment Cards.

If you are an Active member as defined in II.A.1, you are required to complete an enrollment card and must, in order to cover your Dependents, include copies of marriage certificates or Domestic Partner registration certificates, where appropriate, and birth certificates for yourself and for all your Dependents. Proof of full-time student status is required for all dependent children who have attained age 19. (See II.C.1 defining Dependent.)

6. Effective Date of Eligibility.

All members and their Dependents who qualify under the Section II eligibility provisions of this booklet shall be covered effective 12:01 a.m. of the first day on which they qualify.