2. TCC

3. ELIGIBILITY  Participated in a medical plan for at least 90 days or more  Must be enrolled at the time of termination  Can’t be in arrears  Can’t be termed for cause  No TCC provisions for dental

4. TCC ENROLLMENT  Fill out Medical Continuation form  EE must make decision within 60 days of termination  Must become effective on the day of termination (retro)  Employee pays 102% of premium  Different process for HMO TCC & Aetna TCC

5. Filling out HMO TCC Form  Activity name and number at top of form  Prorated amount plus next full month if at the end of the 31 days then next full month  Section 1 g. Day of termination from employment  If for the dependent only then the dependent’s SSN# is imperative as the policy has to be under the dependent not the employee  Please verify premium according to chart. If going into the next premium year give the enrollee the new rate also

6. Sending HMO TCC App/Pymt  Send termination to HMO’S and terminate in P/S. HQ will reinstate (terminate EE the day they terminate even they say they might take a Medical Continuation  Have EE sign, date and give EE a copy of the form  Send the check and Medical Continuation form to lock box  Fax a copy of check and Medical Continuation form to HQ by fax 703-432-0436 Attention: Mary Skinner

7. Sending Aetna TCC App/ Pymt  Terminate in P/S. Aetna will reinstate (terminate EE the day they terminate even if they say they might take a Medical Continuation  Ensure that the designated employer information (Suffix, Account #, Plan, employer signature and etc.) are completed on the application  Employees responsibility to mail the application along with the payment to Aetna 6