Eligibility and Enrollment

Eligibility and Enrollment

Eligibility

You are eligible for accident insurance if you are in active employment with Canon Medical Systems. Active employment means that you are working 20 hours or more per week at a Company work site (including your home) or a location to which your job requires you to travel.

You are not eligible if you are one of the following:

• An employee who is not a citizen or legal resident of the U.S.
• A temporary or season worker.

If you are covered by the plan, you may elect accident insurance for your eligible dependents as follows:

• Your lawful spouse or domestic partner.
• Your unmarried child from birth to 26 years.

Covered dependents receive the same benefit as you.

 

Domestic Partners

Your domestic partner is eligible if:

• You have registered your partner with the California Secretary of State, or
• If you have completed and signed a Partner Enrollment Guide with the Company and meet the domestic partner criteria:
  • Neither of you are married to anyone and you are the sole partners of each other,
  • You are both at least 18 years of age,
  • You are not related by blood closer than would bar marriage in your state,
  • You are both mentally competent to consent to contract,
  • You share a common residence,
  • You have lived together continuously for at least 6 months,
  • You are in a committed and mutually exclusive relationship, and
  • You meet any other requirements listed in the Partner Enrollment Guide. Exception: You will not be required to complete and sign the Partner Enrollment Guide if you have registered your domestic partnership with a governmental body authorizing such a registration and you continue to meet the requirements of that registration. You must file a copy of the registration certification with the Company.

  

Children

A child includes:

• Your natural or adopted child who is dependent on you for support and maintenance
• A child who is placed with you for adoption
• A child who is your stepchild, your domestic partner's child, your foster child, or a child for whom you are legal guardian; the child must be primarily dependent on you for support and live with you in a permanent parent-child relationship
• A child who has an intellectual disability or physical handicap and reaches the maximum age for dependent's insurance, provided you give the insurance company proof that:
  • The child is not capable of self-sustaining employment due to an intellectual disability or physical handicap
  • The child became incapacitated before reaching the maximum age for dependent's insurance
  • The child is chiefly dependent on you for support and maintenance 

Proof must be provided within 31 days after the date the child reaches the maximum age for insurance and when requested at other times by the insurance company (proof may include a doctor examination at the insurance company's expense).

A dependent does not include individuals living outside the United States, on active military duty, or eligible for coverage as an employee.

 

Enrollment

If you are enrolled in a Company medical plan, you will be automatically enrolled in the accident insurance plan at no cost to you. You also have the option to purchase accident insurance for your eligible dependents through convenient payroll deductions.

If you are not enrolled in a Company medical plan, you have the opportunity to purchase accident insurance for yourself and your eligible dependents through convenient payroll deductions (you must have coverage yourself in order to cover your dependents). You may elect accident insurance when you are newly hired and during the annual Open Enrollment.

For spouse coverage, you must provide a copy of your marriage certificate. For domestic partner coverage, you must provide a copy of either a Partner Enrollment Guide or the governmental registration certification.

If you do not have an eligible dependent when you are first eligible to enroll and then gain an eligible dependent at a later date, you may enroll that dependent in the plan within 30 days of acquiring the dependent by contacting the Benefits Department.

If you have enrolled a child and you acquire a new eligible child through birth, marriage, or adoption, the newly eligible child will be covered automatically from the date of the event.

Note: If both you and your spouse/domestic partner are covered by the plan as an employee, then only one, but not both, may cover the same child(ren) under this benefit.

 

Cost

If you are enrolled in a Company medical plan

If you are enrolled in a Company medical plan, you will be automatically enrolled in the accident insurance plan at no cost to you. You may purchase coverage for your dependents through convenient payroll deductions at the following rates:

• Employee + Spouse/DP: $5.09
• Employee + Child(ren): $7.09
• Employee + Spouse/DP + Child(ren): $12.18

 

If you are not enrolled in a Company medical plan

If you are not enrolled in a Company medical plan, you will have the option to purchase coverage for yourself and your dependents through convenient payroll deductions at the following rates:

• Employee only: $5.73
• Employee + Spouse/DP: $10.82
• Employee + Child(ren): $12.82
• Employee + Spouse/DP + Child(ren): $17.91 

 

When coverage begins

If you are enrolled in a Company medical plan, you will be automatically covered by this plan on the date you become eligible. 

If you are not enrolled in a Company medical plan, your coverage will be effective on the latest of the following:

• The date you are eligible for coverage if you apply for dependent coverage on or before that date.
• The date you apply for coverage.
• The date you return to active employment if you are not in active employment when your coverage would otherwise become effective.

Your dependents will be covered on the latest of the following:

• The date your dependent is eligible for coverage if you apply for dependent coverage on or before that date.
• The date you apply for dependent coverage.
• The date you return to active employment if you are not in active employment when your dependent's coverage would otherwise become effective.

 

Making changes to employee-paid coverage

Each year during the Open Enrollment period, you will be able to change your employee-paid accident coverage.

In addition, you may change your coverage at other times during the year if you have a change in your family status as defined by federal regulations.

The following events qualify as a change in your family status:

• Marriage, divorce or legal separation
• Formation or dissolution of a domestic partnership
• Birth or legal adoption of a child
• Death of a spouse/domestic partner or child
• A change in your employment status such that you are no longer regularly scheduled to work at least 20 hours per week

All mid-year changes resulting from a change in family status must be made within 30 days of the event. Any changes you make must be consistent with the change in your family status. You must be actively at work or on vacation for any change in coverage to take effect.

 

When coverage ends

Your coverage ends on the earliest of the following:

• The date the policy is canceled.
• The date you are no longer in an eligible class.
• The date your eligible class is no longer covered.
• The date your child reaches age 26, unless he or she is handicapped as defined above.
• The date coverage is no longer available to dependents under this plan.
• The date you cancel your employee-paid coverage for yourself and/or your dependents.
• The end of the period for which you paid premiums if you stop making a required premium contribution, subject to the grace period.
• The end of the grace period after a premium due date if premium is not paid. 
• The last day you are in active employment unless you are on an approved leave of absence.

 

Leave of Absence

If you are on a Company-approved leave of absence after coverage becomes effective under the policy, and if premiums are paid, your coverage may be continued beyond the date you are no longer in active employment, limited to the time periods described below.

If you are on a leave of absence as described under the Family and Medical Leave Act of 1993 ("FMLA") or applicable state family and medical leave law ("State FML"), your coverage will be continued until the end of the later of:

• The leave period permitted by the federal Family and Medical Leave Act of 1993 and any amendments.
• The leave period permitted by applicable state law.

If you are on a leave of absence other than an FMLA or State FML, and if premium is paid, your coverage will be continued through the end of the month that immediately follows the month in which the leave of absence begins.

If you are approved for more than one type of leave of absence during any one period that you are not in active employment, the plan will consider such leaves to run at the same time for the purpose of determining how long your coverage may continue under the policy.

If your coverage is not continued during an FMLA or State FML Leave of Absence, and you return to active employment immediately following the end of the FMLA or State FML leave of absence, your coverage will be reinstated effective the date you return to active employment.

In no event will your coverage under the policy be continued beyond the date your coverage would otherwise end according to the terms of the termination of coverage provision.

 

Portability

Portability means you have the option to continue your coverage after it would otherwise terminate, if certain conditions are met. You must elect portability before you reach age 70. If you are approved by Voya for portability coverage, dependent coverage may also be continued during portability. 

To continue coverage, you must apply for portability and pay the first premium within 31 days of the date your coverage would otherwise end due to any of the following:

• You retire or terminate employment with the Company.
• The Company cancels coverage for all insured persons and does not replace it with a similar plan.
• You are no longer eligible for coverage under the plan.

Ported coverage is subject to all the terms of this plan.

Premiums will be billed directly to you. Your premium will be based on the portability premium rates in effect at the time you apply for portability. Voya may change the portability premium rates at any time upon 60 days written notice to you. 

Ported coverage will end on the earliest of the following:

• The end of the period in which you stop paying your premium, subject to any applicable grace period at that time.
• The date you die.
• The date the accident insurance policy is canceled and coverage for all insured persons under the policy terminates.

 

Portability for dependents

If you die or divorce, your spouse/domestic partner can apply to continue his or her coverage if: 

• Your spouse/domestic partner is under age 70 at the time they apply for continuation of coverage,
• Your spouse/domestic partner was insured by the plan on the date of your death or divorce, and 
• Your spouse/domestic partner applies for portability and pays the first premium within 31 days of the date of your death or divorce.

If your spouse/domestic partner is approved for portability, he or she will become the owner of the ported coverage. Ported coverage is subject to all the terms of the policy and certificate. 

If your children are covered by this plan on the date of your death and your spouse/domestic partner has been approved for portability, then he or she may also continue coverage for your children.

Premiums will be billed directly to your spouse/domestic partner. The initial premium will be based on the portability premium rates in effect at the time your spouse applies for portability. Voya may change the portability premium rates at any time upon 60 days written notice. 

Coverage continued under this provision will end on the earliest of the following:

• The end of the period in which your spouse/domestic partner stops paying premiums, subject to any applicable grace period at that time.
• The end of the grace period after a premium due date if premium is not paid.
• The date your spouse/domestic partner dies.
• The date your children are no longer eligible for coverage.
• The date the accident insurance policy is canceled and coverage for all insured persons under the policy terminates, upon 60 days written notice of termination.