CVRD Terms of Employee Enrollment
V1.0 | As of September 24, 2025
A. Responsibility to Report Status Changes Promptly
I agree to notify Human Resources at my employer within 30 days if I or any of my eligible dependents experience a qualified family status change such as marriage, divorce, birth, or loss of coverage.
B. Understanding of Coverage and Plan Rules (For Group Sponsored Plan)
I acknowledge that my benefit elections are subject to plan rules, insurance carrier requirements, and applicable laws. I understand certain benefits may require evidence of insurability or approval.
Coordination of Benefits
I understand that if I or my dependents are covered under another health plan, benefits may be coordinated according to plan rules.
C. ACA Declination of Minimum Essential Coverage (MEC) Acknowledgement
By declining the health coverage offered by my employer, I acknowledge and understand the following:
- My employer has offered me health coverage that qualifies as Minimum Essential Coverage (MEC) under the Affordable Care Act (ACA).
- I am voluntarily declining this coverage.
- I understand that by declining this coverage, I will not be able to enroll in the employer-sponsored health plan until the next open enrollment period, unless I experience a qualifying life event that allows for a special enrollment period.
- I acknowledge that declining MEC may affect my eligibility for premium tax credits or subsidies if I seek coverage through the Health Insurance Marketplace.
D. Employer’s Right to Modify or Terminate Plans
I understand my employer reserves the right to amend or terminate benefit plans at any time, subject to applicable laws.
E. ICHRA Plan Acknowledgement
If offered an ICHRA plan:
- The ICHRA is a group health plan for eligible individual health insurance premiums only. This ICHRA does not reimburse other out-of-pocket medical expenses.
- To participate, I must be enrolled in individual health insurance coverage that qualifies as individual health insurance under the rules set forth by the Affordable Care Act. This includes coverage purchased through a public Exchange/Marketplace or directly from an insurance carrier (off-Exchange), but does not include short-term limited duration plans, healthcare sharing ministries, or other non-qualifying coverage.
- I understand that the ICHRA qualifies as an employer-sponsored group health plan for purposes of the Affordable Care Act (ACA). If the ICHRA offer meets ACA affordability standards, I will not be eligible for premium tax credits or subsidies through the Health Insurance Marketplace for the months that I am eligible for the ICHRA.
- I understand that participation in the ICHRA does not make my employer the policyholder or responsible for my individual policy. The policy is owned by me and coverage terms are governed by the insurer issuing my individual plan.
F. Standard Fraud Warning/Enrollment Attestation
Any person who knowingly and with intent to defraud injure or deceive an insurer or other person submits an enrollment for insurance or files a claim containing false, incomplete, or misleading information may be guilty of insurance fraud. Penalties may include fines, restitution, denial of insurance benefits, civil damages, and/or imprisonment depending on state law.
By completing this enrollment, I affirm that all information I have provided is true, complete, and accurate to the best of my knowledge. I understand that providing false, incomplete, or misleading information may result in denial of benefits, termination of coverage, or other consequences as permitted by law.
CVRD Health, Inc. Terms of Employee Enrollment
Version 1.0
Last revised: September 24, 2025