How the Plan Works

Eligibility and enrollment
Effective date of coverage
Payment of benefits
Making changes
When coverage ends
Portability benefit (voluntary coverage only)

Eligibility and Enrollment

You are eligible for critical illness and wellness benefits if you are covered by a CMSU medical plan or other group medical plan.

Enrollment is not required for basic Company-paid coverage – you and your eligible children are automatically covered for the basic Company-paid benefit on your first day of employment.

You may elect to purchase additional critical illness coverage. This provides an increased amount for yourself and coverage for your spouse/domestic partner. Eligible children are automatically included in your voluntary coverage.

Eligible family members include the following:

Your lawful spouse.
Your registered domestic partner who is recognized as equivalent to a spouse by California law.
Your domestic partner if you have completed and signed an affidavit of domestic partnership.
Your child under age 26 who is one of the following:
- Your biological or adopted child (including a child placed for adoption)
- Your stepchild
- A child of your registered domestic partner who is recognized as equivalent to a spouse by California law
- A child of your domestic partner if you have completed and signed an affidavit of domestic partnership
Your or your spouse’s/domestic partner’s child who is age 26 or over who is incapable of self-sustaining employment due to physical or intellectual disability. You must provide proof of the child’s incapacity to Voya’s home office within 31 days after the child reaches the limiting age. Thereafter, you must provide continuing proof annually as required by Voya.

In addition, a child must meet all of the following conditions:

Be unmarried.
Not be on full-time active duty in the armed forces of any country or subdivision thereof.
Legally reside in the United States or its territories or possessions.
Not be insured under the policy as an employee or spouse.

If both you and your spouse or domestic partner are covered by this plan, only one of you may cover your children. If the parent who is covering the children stops being insured as an employee, then the other parent may cover the children under this plan.

Effective Date of Coverage

For basic coverage, you will be covered at 12:01 a.m. Pacific Standard Time on the date you are eligible for coverage. If you enroll when you are first hired, your coverage will be effective on your first day of employment. If you enroll during the annual enrollment period, your coverage will be effective on the following January 1.

For voluntary coverage, you will be covered at 12:01 a.m. Pacific Standard Time on the latest of the following:

The date you are eligible for coverage, if you apply for 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. Exception: Coverage starts on a non-working day if you were in active employment on your last scheduled working day before the non-working day. Non-working days include time off for the following: vacations, personal holidays, weekends and holidays, approved nonmedical leave of absence and paid time off for nonmedical-related absences.

Your spouse or domestic partner will be covered at 12:01 a.m. Pacific Standard Time on the latest of the following:

The date your spouse or domestic partner is eligible for coverage, if you apply for spouse/domestic partner coverage on or before that date.
The date you apply for spouse/domestic partner coverage.
The date you return to active employment, if you are not in active employment when your coverage would otherwise become effective. Exception: Coverage starts on a non-working day if you were in active employment on your last scheduled working day before the non-working day. Non-working days include time off for the following: vacations, personal holidays, weekends and holidays, approved nonmedical leave of absence and paid time off for nonmedical-related absences.

Payment of Benefits

Benefits are payable to you unless otherwise specified. Any accrued benefits that are payable at your death will be paid to the first survivor(s) who is/are living on the date of your death, in the following order:

Your spouse.
Your biological and adopted children, in equal shares.
Your grandchildren, in equal shares.
Your parents, in equal shares.
Your siblings, in equal shares.
Your estate.

If a survivor entitled to receive a payment dies before receiving it, Voya will make payment to that person’s estate.

Making Changes

You can increase or decrease coverage for you or your spouse/domestic partner during the annual enrollment period. New coverage will begin at 12:01 a.m. on the following January 1.

Coverage changes will not affect a claim that occurs before the effective date of the change.

If you are absent from work on the date your change in coverage would normally begin due to injury or sickness any coverage changes will begin on the date you return to active employment.

Any changes to your coverage will affect your dependent children’s coverage.

When Coverage Ends

For You

Your coverage ends on the earliest of the following dates:

The date this policy is cancelled
The last day of the month during which you are no longer in an eligible class
The last day of the month during which your eligible class is no longer covered
The last day of the month during which you voluntarily cancel your coverage
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 the premium is not paid
The last day of the month during which you are no longer in active employment
The date the total maximum benefit amount has been paid for all critical illness

Coverage on your dependent children ends on the earliest of the date your coverage under the policy ends or the date a dependent child no longer meets the definition of dependent children.

For Your Spouse/Domestic Partner and Children

Coverage for your spouse/domestic partner ends on the earliest of the following:

The date your certificate terminates.
The date that coverage for spouses/domestic partners and children is terminated.
The last day of the month during which your child reaches age 26, unless he/she is disabled as defined by this plan. Coverage for a disabled child ends when there is no longer evidence satisfactory to Voya that the disability is continuing.
The last day of the month during which you voluntarily cancel coverage for your spouse/domestic partner.
The last day of the month during which your spouse/domestic partner is no longer eligible.
The end of the period for which premiums are paid, if the next required premium contribution is not paid, subject to the grace period.
The date your spouse’s/domestic partner’s or child’s total maximum benefit amount has been paid for all critical illnesses.

Portability Benefit (Voluntary Coverage Only)

For You

If your employment with CMSU ends or you are no longer in an eligible group, you have the option to apply to continue coverage under the policy for yourself, your spouse if covered, and your eligible children if:

You are under age 70 when you elect portability, and
You apply for portability and pay the first premium within 31 days of the date your coverage would otherwise terminate.

Your continuing coverage will be the same as when you were employed or eligible for coverage. You may decrease, but not increase, the amount of your critical illness coverage. Future changes to the policy will not apply to you. Even if Voya cancels this coverage or closes it for new enrollments, your policy will remain in effect, except as follows:

The following will apply to your portability premiums:

Premiums will be billed directly to you.
Continued premium payment is required to keep coverage in force.
The initial premium will be based on the portability rates in effect at the time you apply for portability.
Voya can change premium rates at any time upon 60 days written notice to you.

Your continuing coverage will end on the earliest of the following:

You don’t pay the required premium within the 31-day grace period.
The date you die.
The date this policy terminates and coverage for all insured persons under the policy terminates, upon 60 days written notice of termination.

For Your Spouse/Domestic Partner

If you die, divorce, or terminate your domestic partnership, your spouse/domestic partner may apply to continue coverage, including eligible dependent children, under this policy if your spouse/domestic partner:

Was insured by this plan on the date of your death or divorce, or termination of domestic partnership,
Is under age 70, and
Applies for portability coverage and pays the first premium within 31 days of the date of your death, divorce, or termination of domestic partnership.

If you die and your spouse/domestic partner applies to continue coverage, any eligible dependent children also will be covered. Critical illness coverage for eligible children will be provided at 25% of your spouse/domestic partner’s critical illness face amount.

Coverage for your spouse/domestic partner will be the same as when he or she was an eligible participant. Your spouse/domestic partner may decrease, but not increase, the amount of critical illness coverage. Future changes to the policy will not apply.

The following will apply to premiums for your spouse’s/domestic partner’s continued coverage:

Premiums will be billed directly to your spouse/domestic partner.
Continued premium payment is required to keep coverage in force.
The initial premium will be based on the portability rates in effect at the time continued coverage is requested.
Voya can change premium rates at any time upon 60 days written notice to your spouse/domestic partner.

Continued coverage for your spouse/domestic partner and children will end on the earliest of the following:

Your spouse/domestic partner doesn’t pay the required premium within the 31-day grace period.
The date your spouse/domestic partner dies.
The date this policy terminates and coverage for all insured persons under the policy terminates, upon 60 days written notice of termination.