Eligibility and Enrollment • You never signed a form explaining the consequences of the employee’s decision. • Your signed form exists but cannot be produced as evidence of the employee’s informed decision.
Coverage for Eligible Retirees You and your Eligible Dependent(s) may be eligible for Valley Health Plan Group Coverage if you are retired. To continue or obtain Coverage as a retired Subscriber: • You must be an Eligible Retiree from a Group that offers VHP as a benefit to its retired employees; • You and your Eligible Dependent(s) must be enrolled in VHP and VHP must receive prepayment fees or premiums from the Group; • You must meet the Group’s eligibility criteria and the Group’s applicable waiting period requirements; • You must reside continuously within the Service Area, San Francisco County, or any adjacent counties to the Service Area. Adjacent counties include: San Mateo, Alameda, Stanislaus, Merced, San Benito, Monterey, and Santa Cruz Counties; and • If you are eligible for Medicare, you must enroll in Medicare and contact your Group and VHP Member Services. To enroll in Valley Health Plan as an Eligible Retiree, contact your employer. Your employer will give you the necessary paperwork, including the VHP application form. Your employer will advise you of your responsibility for any portion of VHP monthly membership fees or premiums. Refer to the “Retiree Continuation of Coverage” section of this EOC.
When Coverage Begins Covered Services begin on the Effective Date of Coverage established by your employer if you enroll: • When you or your Eligible Dependent(s) first became eligible; or • At an Open Enrollment Period; or • Within 31 days of a late enrollment. (Refer to the “Enrolling Late or During Open Enrollment” section.) Covered Services begin for your Dependent: • Newborn natural child—at the moment of birth; or • Adopted child—on the date you obtain adoptive custody or when you receive the legal right to control the adopted Eligible Dependent child’s health care; or • Ward who is an Eligible Dependent child—on the commencement date of legal guardianship. To ensure continued Coverage, you must enroll your newly Eligible Dependent(s) within 31 days after birth, custody, or legal guardianship. If you fail do to so, you must wait until your employer’s next Open Enrollment Period to enroll them.
Continuing Group Coverage for Dependents Health Coverage may continue for your Eligible Dependent(s) as follows: 1. Physically or mentally handicapped Eligible Dependent(s) who is incapable of sustaining 15 V A L L E Y H E A L T H P L A N E V I D E N C E O F C O V E R A G E A N D D I S C L O S U R E F O R M
