Special Notice

 

If the Certificate instructs you to see the enclosed Special Notice, find your Employees Status below. It will tell you when your health coverage ends.

 

Employee Status:  

Date Health Coverage Ends:
   
Furloughed, Suspended or Dismissed Last day of the fourth month following the month in which you last rendered compensated service.

If you have been employed for less than 6 months, coverage may end sooner. Call United Healthcare for assistance.

If you receive vacation pay while you are suspended, your coverage will be measured from the date of your receipt of the vacation pay.
   
Resignation  Date of resignation.
   
Disability See below.
   
Any other status (Including Retirement) Last day of the month following your last rendered compensated service.

  

Disabled Employees

 

If you left compensated service due to disability, your employee health coverage will continue as long as you remain continuously disabled, but not beyond the last day of the second calendar year after the year of your last compensated service.1 Your dependents’ health coverage will continue as long as you remain continuously disabled, but not beyond the last day of the first calendar year after the year of your last compensated service.

 

If you receive vacation pay, the extension of coverage described above will be measures from the date you receive the vacation pay provided you have not terminated your employment relationship before you receive the vacation pay.

 

The Plan cannot assume that you remain continuously disabled. You must submit proof of your disability to your medical benefits administrator (United Healthcare, Regence Life and Health or Aetna U. S. Healthcare). A physician’s statement confirming your continuous disability will ordinarily be sufficient.

 

If you need an exact date of termination of coverage for a new employer, call United Healthcare at 1-800-842-5252.