R99-153 AUTHORIZING AGREEMENT - Laserfiche WebLink

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11. Enroliment: Special Enrollment: An Eligible Person may apply for coverage, Family coverage or add dependents within thirty-one (31) days of a qualifying event if he/she did not apply prior to his/her Eligibility Date or when eligible to do so. Such person's Coverage Date, Family Coverage Date, and/or dependent's Coverage Date will be the effective date of the qualifying event or, in the event of Special Enrollment due to termination of previous coverage, the date of application of coverage. Late Enro/lment. An Eligible Person may apply for coverage, Family coverage or add dependents if he/she did not apply prior to his/her Eligibility Date or did not apply when eligible to do so. Such person's Coverage Date, Family Coverage Date, and/or dependent's Coverage Date will be a date mutually agreed to by the Claim Administrator and the Employer. Open Enro/lment An Eligible Person may apply for coverage, Family coverage or add dependents if he/she did not apply prior to his/her Eligibility Date or did not apply when eligibte to do so, during the Employer's Open Enrollment Period. • Specify Open Enrollment Period: Such person's Coverage Date, Family Coverage Date, and/or dependent's Coverage Date will be a date mutually agreed to by the Claim Administrator and the Employer. Such date shall be subsequent to the Open Enrollment Period. 12. Extension of Coverage due to Temporary Layoff, Leave of Absence or Disability shall be a period of none. I However,benefits shall be extended for the duration of an Eligible Person's leave in accordance with the Family and Medical Leave Act of 1993,as amended. IN WITNESS WHEREQ�F,the Employer hereby duly executes this Adoption Agreement and the Plan this , day of l`'�A��l , t8 2�0� For: � i�� F ��c�R`ri�rZ. By: �TC��C'_ ��f�Q.�W� P ' tN By: ture Title: O��1�2��' •'� ATTEST: � / ,,� � ' -C �-�c� . �o/I�L�� - Title: