21 ©2024 United Benefit Advisors, LLC. All rights reserved. Additional Notices for New Enrollees Notice of Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, 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). 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 dependents. However, you must request enrollment within “30 days” after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact: Name of Entity/Sender ° Contact ° ° Phone Number Snellings Walters Brannon Johnston 770-508-3005