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2.5.2 Newly Acquired Family Members. Eligible employees and their newly acquired family <br />members may enroll following marriage or registration of a domestic partnership; court <br />appointed legal guardianship of a Child; or issuance of a QMCSO by submitting an <br />enrollment application and the applicable Premium to the Policyholder no later than 31 <br />days after the event. Eligible employees or eligible family members may enroll if he/she <br />becomes newly eligible for premium assistance under Children's Health Insurance <br />Program (CHIP) or Medicaid by submitting an enrollment application and the applicable <br />Premium to the Policyholder no later than 60 days after the determination for eligibility of <br />premium assistance. Coverage will begin on the first day of the month after receipt of the <br />enrollment application. <br />2.5.3 Loss of Coverage. Eligible employees or their eligible family members may enroll <br />following the loss of coverage under another dental plan Reasons for the loss of coverage <br />may include exhaustion of COBRA continuation coverage, Toss of eligibility (including as a <br />result of legal separation, divorce, dissolution of domestic partnership, death, termination <br />of employment, or reduction in the number of hours of employment), termination of <br />premium assistance under CHIP or Medicaid, or reduction in employer contribution towards <br />coverage. An enrollment application must be submitted no later than 31 days after the loss <br />of coverage or no later than 60 days if the loss of coverage was CHIP or Medicaid. <br />Coverage will begin on the first day of the month after receipt of the enrollment application. <br />001 L-WA811(5/20) 5 <br />