14 You must apply 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 initial 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 enroll the new dependent within 60 days to ensure coverage for your dependent. If you do not enroll your dependent within 60 calendar days, unless you experience a special enrollment event, enrollment for coverage will be delayed until your Employer’s next Open Enrollment period.. 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 paid 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 within 60 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 failure 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 yourself, and your new dependent(s), provided that you request enrollment within 60 days after the marriage, birth, adoption, or placement for adoption. If you fail to enroll within the Special Enrollment window, you may enroll yourself and/or your new dependent(s) during your Employer’s next Open Enrollment period. 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 adoption 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.