If you decline enrollment for medical benefits for yourself or your eligible dependents (including
your spouse) in the Ithaca College Medical Plan (“the Plan”) because of other health insurance or
group health plan coverage, you may be able to enroll yourself and your eligible dependents in the
medical benefits provided under the Plan if you or your eligible dependents lose eligibility for that
coverage (or if the employer stops contributing toward you or your eligible dependents’ other
coverage). However, you must request enrollment in the Plan within 60 days ater you or your dependents’ other coverage ends (or ater the employer stops contributing toward the other coverage).
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, your spouse and your new eligible dependent children. However, you must request enrollment within 30 days ater the marriage, birth, adoption, or
placement for adoption. If you request a change due to a special enrollment event within the 30
day timeframe, coverage will be effective the date of birth, adoption or placement for adoption.
For all other events, coverage is effective as of the event date that makes you eligible.
The Ithaca College Medical Plan must allow a HIPAA special enrollment for employees and eligible
dependents who are not enrolled if they lose Medicaid or CHIP coverage because they are no longer eligible, or if they become eligible for a state’s premium assistance program. Employees have 60
days from the date of the Medicaid/CHIP event to request enrollment under the Ithaca College
Medical Plan. If you request this change, coverage is effective as of the event date that makes you
eligible. Specific restrictions may apply, depending on federal and state law. To request special
enrollment or obtain more information, contact the Employee Benefits & Work/Life Department at