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© Hitesman & Wold, P.A. 2019 <br />Cafeteria Plan <br />Summary Description (3-11) <br />11 <br />children’s health insurance program (“SCHIP”), a medical care program of an <br />Indian Tribal government, the Indian Health Service, or a tribal organization; a <br />state health benefits risk pool; or a foreign government health plan ), you may <br />make or change your election to pay the cost of such coverage under the Cafeteria <br />Plan. <br />NOTE: Certain changes to an individual’s coverage under a state children’s health <br />insurance program (“SCHIP”) also create a HIPAA special enrollment <br />right. Election changes based upon HIPAA special enrollment rights are described <br />above. <br /> <br />(6) Enrollment in Marketplace Coverage. <br />(A) If you have made an election to pay for Group Medical Plan coverage, you <br />may revoke that election if the following conditions are satisfied: <br />(i) You either (1) are eligible to enroll in a qualified health plan <br />through a public insurance exchange (the “Marketplace”) via a <br />special enrollment period (as provided in any guidance issued by <br />the Department of Health and Human Services or any other <br />applicable guidance), or (2) seek to enroll in a qualified health <br />plan through the Marketplace during the Marketplace’s annual <br />open enrollment period; <br />(ii) You cancel coverage under the Group Medical Plan in accordance <br />with the requirements of that plan; and <br />(iii) You, and any related individuals who were also enrolled in the <br />Group Medical Plan, have enrolled in or intend to enroll in a <br />qualified health plan through the Marketplace that will be effective <br />no later than the day immediately following the last day for which <br />coverage under the Group Medical Plan was effective (i.e., there <br />is no break in coverage). The Plan Administrator may rely on your <br />reasonable representation that the requirements of this paragraph <br />(iii) are met. <br />(B) If you have made an election to pay for Group Medical Plan coverage, you <br />may reduce that election if the following conditions are satisfied: <br />(i) Your spouse and/or dependents either (1) are eligible to enroll in <br />a qualified health plan through the Marketplace via a special <br />enrollment period (as provided in any guidance issued by the <br />Department of Health and Human Services or any other applicable <br />guidance), or (2) seek to enroll in a qualified health plan through <br />the Marketplace during the Marketplace’s annual open enrollment <br />period; <br />(ii) You cancel coverage under the Group Medical Plan for such <br />spouse and/or dependents in accordance with the requirements <br />of that plan; and <br />(iii) Such spouse and/or dependents have enrolled in or intend to <br />enroll in a qualified health plan through the Marketplace that will