Name
Michigan Catholic Conference
Phone
(800) 395-5565
Fax
(517) 372-3940
Address
510 S. Capitol Ave.
Lansing, MI 48933

Special Enrollment Rights

Our records show that you are eligible to participate in the Michigan Catholic Conference Group Health Plans. A federal law called HIPAA requires that we notify you about your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, if you lose certain Medicaid coverage or become eligible for a Medicaid premium subsidy, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.

Special Enrollment Provision

Loss of Other Coverage

If you decline enrollment for yourself or for an eligible dependent while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

New Dependent by Marriage, Birth, Adoption, or Placement for Adoption

In addition, 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 new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

Affected Medicaid Coverage

If you or an eligible dependent lose eligibility for coverage and coverage is terminated under a Medicaid plan (under Title XIX of the Social Security Act) or under a State child health plan (under Title XXI of the Social Security Act), or if you or an eligible dependent become eligible for premium assistance with respect to coverage under the Plan under such Medicaid plan or State child health plan, you may be able to enroll yourself and your affected dependents as long as you request enrollment within 60 days.

To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact the Michigan Catholic Conference Employee Benefits Team, 510 South Capitol Avenue, Lansing, Michigan 48933, or call at 800.395.5565, or email Benefits@micatholic.org.

If you have questions on any of the information contained in this notice you may contact MCC Employee Benefits team at 800.395.5565, by email to Benefits@micatholic.org, or by mail at 510 South Capitol Avenue Lansing, MI 48933. You may visit www.micatholic.org to obtain additional information.

Name
Michigan Catholic Conference
Phone
(800) 395-5565
Fax
(517) 372-3940
Email
Address
510 South Capitol Avenue
Lansing, Michigan 48933
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