12 under a QMCSO will terminate when your coverage terminates for any reason, subject to the dependent child’s right to elect COBRA Continuati on Coverage (if that right applies). You may obtain a copy of the Plan’s procedures governing QMCSOs without charge from the Fund Office. If you have any questions about QMCSOs contact the Fund Office. How to Enroll in Coverage Under the Plan You must app ly for coverage for yourself and your dependents by completing an enrollment form and providing the completed form to your Employer. Your Employer will process the form and initiate any necessary payroll deduction, indicate the effective date of coverage, and provide the form to the Fund Office. Coverage for you, your Spouse, and/or Eligible Dependent Children will not be effective until the Fund Office receives and processes the form. Enrollment forms should be received by the Fund Office prior to your ini tial effective date for coverage. If submission prior to your effective date is not possible, your form must be received by the Fund Office before the end of the initial coverage month. If you acquire a new dependent, you should notify your Employer and e nroll the new dependent within 30 days to ensure coverage for your dependent. If you do not enroll your dependent within 30 calendar days, unless you experience a special enrollment event, enrollment for coverage will be delayed until your Employer’s Open Enrollment period. If your employer does not have an Open Enrollment period, the Fund Office can assign an Annual Enrollment period during which changes will be allowed. Please contact the Fund Office if you have any questions about when a dependent can be enrolled and the date the individual will qualify as a dependent. If you fraudulently enroll someone who is not eligible for coverage, that person’s coverage will be terminated immediately . The Fund has a right to be reimbursed of any claims that were pa id based on the fraudulent enrollment. You also may be subject to criminal penalties. Special Enrollment During Mid - Coverage Period If you, your Spouse, or your Eligible Dependent Children are declining coverage because of other health insurance coverage, in the future you may be able to enroll yourself, your spouse, or your dependents in this Plan, provided you request enrollment with in 30 calendar days after coverage under the other plan ends. The dependent’s loss of coverage must be due to exhaustion of continuation coverage under another plan, termination resulting from the loss of eligibility under the other plan, termination as a result of increase in cost of coverage under the other plan, or termination because Employer contributions under the other plan were reduced or terminated. Loss of coverage for this purpose does not include a loss due to the individual or participant’s fa ilure to make payments on a timely basis under the applicable terms, or termination of coverage for cause. If you have a new dependent as a result of marriage, birth, or placement for adoption, you may enroll your new dependent, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you fail to enroll your new dependent within the Special Enrollment time period , you may enroll your new dependent during your Employer’s next Open Enrollment peri od. If your Employer does not have an Open Enrollment period, the Fund Office can assign an Annual Enrollment period during which changes will be allowed. Please contact the Fund Office if you have any questions about when a dependent can be enrolled and t he date the individual will qualify for dependent coverage under the Plan. A child will be considered placed for adoption when you become legally obligated to support that child, totally or partially, prior to that child’s adoption. If a child placed for a doption is not adopted, all health coverage ceases when the placement ends, and will not be continued. Please contact the Fund Office if you have any questions about Special Enrollment.