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Summary Plan Description (SPD)
Enrollment Procedures
When you first become eligible for benefits (as explained in the table of contents section "Eligibility and General Plan Provisions" under the section subtitled, "Eligibility, When Coverage Begins") you will be allowed to choose the Medical and Dental Plans of your choice by completing forms provided by the Fund and filing them with the Fund Offices. You and your dependents will always be enrolled in the same Plans.
If you do not select a medical plan, you shall be automatically enrolled in the Self-Funded Indemnity Medical Plan. If you do not select a dental plan, you shall be automatically enrolled in the Self-Funded Indemnity Dental Plan. In these instances, you will receive a letter from the Administrative Office advising you of your automatic enrollment in either the Self-Funded Indemnity Medical Plan and/or the Self-Funded Indemnity Dental Plan. You will have a last chance 30 days from the date of this default letter to make a selection of another medical or dental plan. For example, if the default letter is dated June 3rd, you will have until July 2nd (30 days from the date of the default letter) to make a plan selection. The plan selection would need to be received by the Administrative Office by July 2nd, for an effective date of coverage of August 1. Change of coverage forms received after the 15th day of the month, will provide coverage to the new plan(s) effective the first day of the month following the next month thereafter. For example, timely change of coverage form received on July 16th in the Administrative Office, will provide that the plan(s) change be effective September 1st.
You may enroll in an HMO Plan only if you are within the geographical jurisdiction as defined by the HMO you select. For PacifiCare, you must live or work within a 30-mile radius of a PacifiCare participating provider (doctor/medical group). For Kaiser, you must live or have your principal place of work within the Kaiser zip code area, which consists of an approved listing of zip codes.
To determine if you are within either the PacifiCare or Kaiser service area you have two options for each HMO. For PacifiCare call Member Services at (800) 624-8822, or log on to the PacifiCare website at www.pacificare.com. For Kaiser call Member Services at (800) 464-4000, or log on to the Kaiser website at www.kp.org.