LAPRA 2018 Legally Required Notices

• If your spouse or dependent is not enrolled in a LAPRA plan, you may add them to your coverage only if: – You had declined coverage for your spouse or dependent because your spouse or dependent was covered under another plan (including federal COBRA continuation coverage) and your spouse or dependent loses eligibility for coverage under that plan (or in the case of federal COBRA coverage, your spouse or dependent exhaust such coverage). – In certain very limited circumstances, if your coverage under the LAPRA plan you have selected is reduced (for example, there is a significant increase in your deductible), you may be allowed to elect coverage in another plan available through LAPRA. In addition, in certain very limited circumstances, if you experience a complete loss of coverage under a LAPRA plan (for example, an HMO is no longer available where you live), you may be allowed to elect coverage under another LAPRA plan or drop coverage entirely. – You are called to or return from active duty in the uniformed services. Domestic Partners: Domestic partners may also be enrolled for coverage according to the applicable plan procedures. The enrollment of domestic partners who are not otherwise your dependent, however, is not governed by Section 125. Submission of Enrollment Form for Election Change: Any request to change your election according to the rules set forth above must be made within 31 days after the event for which a change in election is permitted. The change in election will generally be effective the first day of the month following receipt of the enrollment form by LAPRA. If your request is not received within 31 days, you must wait until the next enrollment period. If you have questions about the circumstances under which you may change your benefit elections, please call our office at 213-674-3701 or 888-252-7721 or send an email to benefits@lapra.org . Notice Regarding Summary of Benefits and Coverage (SBC) The plans offered by LAPRA offer a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, LAPRA makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options. The SBC is available on the web at www.lapra.org/tools.html . A paper copy is also available, free of charge, by calling LAPRA at 213-674-3701 or 888-252-7721 or send an email to benefits@lapra.org . Los Angeles Police Relief Association, Inc. Health Plan Notice of Privacy Practices The Los Angeles Police Relief Association, Inc. Health Plan Notice of Privacy Practices is available online at www.lapra.org/privacy.html . You may also request a copy by calling LAPRA at 213-674-3701 or 888-252-7721 or send an email to benefits@lapra.org . Domestic Partners Domestic partners may be enrolled for coverage according to the applicable plan procedures as described in the Eligibility Guide which is available at www.lapra.org on the Tools & Resources page. Submission of Enrollment Form for Election Change Any request to change your election must be made within 31 days after the event for which a change in election is permitted. The change in election will generally be effective the first day of the month following the event. If your request is not received within 31 days, you must wait until the next enrollment period. 2