Another set of richtext that looks different between WPTools 4 and 5. This one seems to be on when the page breaks occur. Notice on the first page that the pagebreak occurs before the Sincerely, but in WPTools 5, both the {M018} and {M019} get on the page. Also, on page 3, following the forced page break on page 2, the page break for WPTools 4 occurs before the How can you elect continuation coverage? section while in 5 it is after.
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\listid1194737}}{\*\listoverridetable{\listoverride\listid1194737\listoverridecount0\ls1}}\endnhere\sectdefaultcl{\pard{\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{B001\}\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M005\}\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \{B011\}\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 Dear \{M301\}:\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M059\}\par
{\tx10980 \qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 This notice contains important information about your right to continue your health care coverage in the \{M001\} \plain\f1\fs20\cf16 Group Health Plan (the Plan).\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
}\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Please read the information contained in this notice very carefully. This notice provides important information \plain\f1\fs20\cf16 concerning your rights and what you have to do to continue your health care coverage under the Plan for you and \plain\f1\fs20\cf16 your covered dependents, if any, as defined on the enclosed Family Member Enrollment Form. If you have any \plain\f1\fs20\cf16 questions concerning the information in this notice or your rights to coverage, you should contact\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M022\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M023\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M024\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M025\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 If you do not elect to continue your health care coverage by completing the enclosed \'93Enrollment Form\'94 and \plain\f1\fs20\cf16 returning it to us, your coverage under the Plan will end on \{M013\} due to: \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M014\} on the qualifying event date of \{M026\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Each of the following qualified beneficiaries is being offered continuation under the Plan:\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M301\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Because of the above event that will end your coverage under the Plan, you are entitled to continue your health \plain\f1\fs20\cf16 care coverage for up to \{M012\}. If you elect to continue your coverage under the Plan, your continuation coverage \plain\f1\fs20\cf16 will begin on \{M013\} and can last until \{M039\}.\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b IMPORTANT \'96 To elect continuation coverage, you MUST complete the enclosed \'93Enrollment Form\'94 and \plain\f1\fs20\cf16\b return it to us. You may mail it to the address shown on the Enrollment Form. The completed Enrollment \plain\f1\fs20\cf16\b Form must be post-marked by \{M015\}. If you do not submit a completed Enrollment Form by this date, you \plain\f1\fs20\cf16\b will lose your right to elect continuation coverage.\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16\b \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf17 Also, since each covered dependent has the equal right to accept or decline the coverage being offered them, if not \plain\f1\fs20\cf17 all members of your family who are eligible for the coverage offered wish to continue coverage, please indicate \plain\f1\fs20\cf17 that as well on the Dependent/Family Member Enrollment Form, if enclosed. Should some but not all of your \plain\f1\fs20\cf17 dependents wish to continue coverage, you are welcome to call the telephone number shown to obtain information \plain\f1\fs20\cf17 about specific premium amounts due.\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf17 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf17 The total premiums due each month is shown on the Enrollment Form and on the Premium Computation Form. \plain\f1\fs20\cf17 You should pay the total premium due at the time you send in the Enrollment Form, in order to complete your \plain\f1\fs20\cf17 enrollment and continue your coverage. However, you are allowed to delay the premium payment for up to \plain\f1\fs20\cf17 forty-five days after you have signed, dated and submitted your Enrollment Form. Any claims submitted for \plain\f1\fs20\cf17 expenses incurred following the date of the Qualifying Event may be held in suspense until all premiums which \plain\f1\fs20\cf17 are due have been paid.\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf17 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf17 Future premiums are due on the first of each month thereafter, and should be mailed on or before the due date. \plain\f1\fs20\cf17 Failure to pay premiums by premium due dates may terminate your participation in the Health Benefits \plain\f1\fs20\cf17 Continuation Plan. \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \{B029\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 If you have any questions about the coverage, its length or the premiums due, please call \{M016\} at \{M017\} \plain\f1\fs20\cf16 during regular business hours.\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 Sincerely,\par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri1440\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M018\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M019\}\par
\page\qc\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs24\cf16\b\ul IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION \plain\f1\fs24\cf16\b\ul COVERAGE RIGHTS\par
\qc\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul What is continuation coverage?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Federal law requires that most group health plans (including this Plan) give employees and their families the \plain\f1\fs20\cf16 opportunity to continue their health care coverage when there is a \'93qualifying event\'94 that would result in a loss of \plain\f1\fs20\cf16 coverage under an employer's plan. Depending on the type of qualifying event, \'93qualified beneficiaries\'94 can \plain\f1\fs20\cf16 include the employee covered under the group health plan, a covered employee's spouse, and dependent children of \plain\f1\fs20\cf16 the covered employee.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the \plain\f1\fs20\cf16 Plan who are not receiving continuation coverage. Each qualified beneficiary who elects continuation coverage \plain\f1\fs20\cf16 will have the same rights under the Plan as other participants or beneficiaries covered under the Plan. The \plain\f1\fs20\cf16 persons listed on page one of this notice have been identified by the Plan as qualified beneficiaries entitled to elect \plain\f1\fs20\cf16 continuation coverage. Specific information describing continuation coverage can be found in the Plan's summary \plain\f1\fs20\cf16 plan description (SPD), which can be obtained from \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{B001\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul How long will continuation coverage last?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 In the case of a loss of coverage due to end of employment or reduction in hours of employment, coverage \plain\f1\fs20\cf16 generally may be continued for up to 18 months. In the case of losses of coverage due to an employee's death, \plain\f1\fs20\cf16 divorce or legal separation, the employee's becoming entitled to Medicare benefits or a dependent child ceasing to \plain\f1\fs20\cf16 be a dependent under the terms of the plan, coverage may be continued for up to 36 months. Page one of this \plain\f1\fs20\cf16 notice shows the maximum period of continuation coverage available to the listed qualified beneficiaries.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Continuation coverage will be terminated before the end of the maximum period if any required premium is not \plain\f1\fs20\cf16 paid on time, if a qualified beneficiary becomes covered under another group health plan that does not impose any \plain\f1\fs20\cf16 pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary, if a covered employee \plain\f1\fs20\cf16 enrolls in Medicare, or if the employer ceases to provide any group health plan for its employees. Continuation \plain\f1\fs20\cf16 coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary \plain\f1\fs20\cf16 not receiving continuation coverage (such as fraud).\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul How can you extend the length of continuation coverage?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 If you elect continuation coverage, an extension of the maximum period of 18 months of coverage may be \plain\f1\fs20\cf16 available if a qualified beneficiary is disabled or a second qualifying event occurs. You must notify \{M022\} of a \plain\f1\fs20\cf16 disability or a second qualifying event in order to extend the period of continuation coverage. Failure to provide \plain\f1\fs20\cf16 notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\i Disability\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 An 11-month extension of coverage may be available if any of the qualified beneficiaries is disabled. The Social \plain\f1\fs20\cf16 Security Administration (SSA) must determine that the qualified beneficiary was disabled at some time during the \plain\f1\fs20\cf16 first 60 days of continuation coverage, and you must notify \{M022\} of that fact within 60 days of the SSA's \plain\f1\fs20\cf16 determination and before the end of the first 18 months of continuation coverage. All of the qualified beneficiaries \plain\f1\fs20\cf16 listed on page one of this notice who have elected continuation coverage will be entitled to the 11-month disability \plain\f1\fs20\cf16 extension if one of them qualifies. If the qualified beneficiary is determined by SSA to no longer be disabled, you \plain\f1\fs20\cf16 must notify \{M022\} of that fact within 30 days of SSA's determination.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\i Second Qualifying Event\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 An 18-month extension of coverage will be available to spouses and dependent children who elect continuation \plain\f1\fs20\cf16 coverage if a second qualifying event occurs during the first 18 months of continuation coverage. The maximum \plain\f1\fs20\cf16 amount of continuation coverage available when a second qualifying event occurs is 36 months. Such second \plain\f1\fs20\cf16 qualifying events include the death of a covered employee, divorce or separation from the covered employee or a \plain\f1\fs20\cf16 dependent child's ceasing to be eligible for coverage as a dependent under the Plan. You must notify \{M022\} \plain\f1\fs20\cf16 within 60 days after a second qualifying event occurs.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul How can you elect continuation coverage?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Each qualified beneficiary listed on page one of this notice has an independent right to elect continuation \plain\f1\fs20\cf16 coverage. For example, both the employee and the employee's spouse may elect continuation coverage, or only one \plain\f1\fs20\cf16 of them. Parents may elect to continue coverage on behalf of their dependent children only. A qualified \plain\f1\fs20\cf16 beneficiary must elect coverage by the date specified on the Election Form. Failure to do so will result in loss of \plain\f1\fs20\cf16 the right to elect continuation coverage under the Plan. A qualified beneficiary may change a prior rejection of \plain\f1\fs20\cf16 continuation coverage any time until that date.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 In considering whether to elect continuation coverage, you should take into account that a failure to continue your \plain\f1\fs20\cf16 group health coverage will affect your future rights under federal law. First, you can lose the right to avoid having \plain\f1\fs20\cf16 pre-existing condition exclusions applied to you by other group health plans if you have more than a 63-day gap in \plain\f1\fs20\cf16 health coverage, and election of continuation coverage may help you not have such a gap. Second, you will lose \plain\f1\fs20\cf16 the guaranteed right to purchase individual health insurance policies that do not impose such pre-existing \plain\f1\fs20\cf16 condition exclusions if you do not get continuation coverage for the maximum time available to you. Finally, you \plain\f1\fs20\cf16 should take into account that you have special enrollment rights under federal law. You have the right to request \plain\f1\fs20\cf16 special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by \plain\f1\fs20\cf16 your spouse's employer) within 30 days after your group health coverage ends because of the qualifying event \plain\f1\fs20\cf16 listed above. You will also have the same special enrollment right at the end of the continuation coverage if you \plain\f1\fs20\cf16 get continuation coverage for the maximum time available to you.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf18\b\ul How much does COBRA continuation coverage cost?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf18 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf18 Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage. The amount \plain\f1\fs20\cf18 a qualified beneficiary may be required to pay may not exceed 102 percent (or, in the case of an extension of \plain\f1\fs20\cf18 continuation coverage due to a disability, 150 percent) of the cost to the group health plan (including both \plain\f1\fs20\cf18 employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is \plain\f1\fs20\cf18 not receiving continuation coverage. The required payment for each continuation coverage period for each option \plain\f1\fs20\cf18 is described in this notice.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf18 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul What if I am eligible for trade adjustment assistance?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 The Trade Act of 2002 created a new tax credit for certain individuals who become eligible for trade adjustment \plain\f1\fs20\cf16 assistance and for certain retired employees who are receiving pension payments from the Pension Benefit \plain\f1\fs20\cf16 Guaranty Corporation (PBGC) \plain\f1\fs20\cf19 (eligible individuals)\plain\f1\fs20\cf16 . Under the new tax provisions, eligible individuals can either \plain\f1\fs20\cf16 take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including \plain\f1\fs20\cf16 continuation coverage. If you have questions about these new tax provisions, you may call the Health Care Tax \plain\f1\fs20\cf16 Credit Customer Contact Center toll free at 1-866-628-4282. TTD/TTY callers may call toll free at \plain\f1\fs20\cf16 1-866-626-4282. More information about the Trade Act is also available at \plain\f1\fs20\cf3\uldb\ul www.doleta.gov/tradeact/2002act_index.asp\plain\f2\fs22\cf0\v http://www.doleta.gov/tradeact/2002act_index.asp\plain\f1\fs20\cf16\v http://www.doleta.gov/tradeact/2002act_index.asp\plain\f1\fs20\cf16 .\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21\b\ul When and how must payment for continuation coverage be made?\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21\i First payment for continuation coverage\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21 If you elect continuation coverage, you do not have to send any payment for continuation coverage with the \plain\f1\fs20\cf21 Election Form. However, you must make your first payment for continuation coverage within 45 days after the \plain\f1\fs20\cf21 date of your election. (This is the date the Election Notice is post-marked, if mailed.) If you do not make your \plain\f1\fs20\cf21 first payment for continuation coverage in full not later than 45 days after the date of your election, you will lose \plain\f1\fs20\cf21 all continuation coverage rights under the Plan.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21 Your first payment must cover the cost of the continuation coverage from the time your coverage under the Plan \plain\f1\fs20\cf21 would have otherwise terminated up to the time you make the first payment. You are responsible for making sure \plain\f1\fs20\cf21 that the amount of your first payment is enough to cover this entire period. You may contact \{M022\} to confirm \plain\f1\fs20\cf21 the correct amount of your first payment.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf21 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Your first payment for continuation coverage should be sent to:\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M022\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M023\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M024\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M025\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\i Periodic payments for continuation coverage\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 After you make your first payment for continuation coverage, you will be required to make periodic payments for \plain\f1\fs20\cf16 each subsequent coverage period. Under the Plan, these periodic payments for continuation coverage are due on \plain\f1\fs20\cf16 the first day of each month. If you make a periodic payment on or before the first day of the coverage period to \plain\f1\fs20\cf16 which it applies, your coverage under the Plan will continue for that coverage period without any break. The Plan \plain\f1\fs20\cf16 \{M307\} send periodic notices of payments due for these coverage periods.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\i Grace periods for periodic payments\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 Although periodic payments are due on the dates shown above, you will be given a grace period of 30 days after \plain\f1\fs20\cf16 the first day of the coverage period to make each periodic payment. Your continuation coverage will be provided \plain\f1\fs20\cf16 for each coverage period as long as payment for that coverage period is made before the end of the grace period for \plain\f1\fs20\cf16 that payment. However, if you pay a periodic payment later than its due date but during its grace period, your \plain\f1\fs20\cf16 coverage under the Plan may be suspended as of the due date and then retroactively reinstated (going back to the \plain\f1\fs20\cf16 due date) when the periodic payment is made. This means that any claim you submit for benefits while your \plain\f1\fs20\cf16 coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 If you fail to make a periodic payment before the end of the grace period for that payment, you will lose all rights \plain\f1\fs20\cf16 to continuation coverage under the Plan.\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf20 Your first payment and all periodic payments for continuation coverage should be sent to:\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf20 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf20 \{M022\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf20 \{M023\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf20 \{M024\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf20 \{M025\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\i If information is available about alternative coverage (coverage in lieu of continuation coverage, or individual \plain\f1\fs20\cf16\i conversion rights), it will appear here: NONE AVAILABLE\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul For more information\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 This notice does not fully describe continuation coverage or other rights under the Plan. More information about \plain\f1\fs20\cf16 continuation coverage and your rights under the Plan is available in your summary plan description or from the \plain\f1\fs20\cf16 Plan Administrator. You can get a copy of your summary plan description from: \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M022\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M023\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M024\}\par
\qj\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \{M025\}\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and \plain\f1\fs20\cf16 Accountability Act (HIPAA), and other laws affecting group health plans, contact the U.S. Department of Labor's \plain\f1\fs20\cf16 Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa\plain\f1\fs20\cf16\v http://www.dol.gov/ebsa\plain\f1\fs20\cf16 .\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16\b\ul Keep Your Plan Informed of Address Changes\par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0 \plain\f1\fs20\cf16 In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the \plain\f1\fs20\cf16 address of family members. You should also keep a copy, for your records, of any notices you sent to the Plan \plain\f1\fs20\cf16 Administrator.\par
\ql\li0\fi0\ri0\sb0\sl\sa0\toc1 \plain\f1\fs20\cf16 \par
\ql\li0\fi0\ri0\sb0\sl\sa0\toc1 \plain\f1\fs20\cf16 }}
}
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