Kaiser DC Group # 2863-0
This HMO is available to participants who first become newly eligible, or reinstated from a prior cover period through covered employment, in addition to living in this HMO's service area. It is also available to all eligible participants during the Health Fund's Annual Open Enrollment Period, November of each year, in which the coverage effective date will be the first day of the following year, January 1.
If you know that you will be traveling extensively during your health coverage period, selecting an HMO is not recommended. Generally, in such plans, you must receive all medical services from a doctor or health care provider who works at the HMO’s facilities or is affiliated with the HMO. You will not be covered for services from a provider who is not affiliated with an HMO, except in a medical emergency, which must be approved by the HMO.
If you have Primary health coverage through another Plan, an HMO will not be available to you. Coordination of Benefits (COB) is not permitted with an HMO. In this instance, the CIGNA Open Access Plus (OAP) Plan will be the only available plan to choose from.
We have provided you with the following items in order to complete the enrollment process under this HMO:
The completed enrollment application, along with your $100 Quarterly Premium Contribution Payment, must be returned by the due date indicated on your billing invoice, which is always the first day of the month prior to the start of the coverage period. In the event of the Annual Open Enrollment Period, the due date will be November 30th of each calendar year. HMO applications received after the due date will be returned, and the next HMO enrollment opportunity will be the next available Open Enrollment Period.
To elect dependant coverage, enter the dependent information directly on to the hmo enrollment form. For a listing of quarterly dependent premium rates click here dependent premium rates. Failure to pay in advance for dependent coverage will result in the Fund Office enrolling you for single coverage only. PLEASE NOTE: DEPENDENT COVERAGE CAN ONLY BE ELECTED IF THE $100 QUARTERLY PREMIUM CONTRIBUTION IS PAID. You can include the payment for dependent coverage along with the $100 quarterly contribution premium on one check.
The completed enrollment application and payment are to be mailed to:
Equity-League Health Trust Fund
P.O Box 11533
New York, NY 10286-1533
To pay by credit card, click on the Health Care Payments link http://www.equityleague.org/store/index.html for additional details.
If your permanent residency changes outside of this HMO's service area, please return to the Summary of HMO of Benefits listing to see if another HMO will be available to you. If no others apply, the CIGNA OAP Plan becomes your only plan option to choose from. The Health Fund's HMO Coordinator will need to be notified to assist you in the change of benefits process.
For any questions or assistance, please contact the Health Department within the Fund Office to speak to the Fund's HMO Coordinator.
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