Notice of Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose elig ibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops cont ributing toward the other coverage). I f you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. I f you or your dependent(s) lose coverage under a state Children’s Health Insurance Program (CHIP) or Medicaid , you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the loss of CHIP or Medicaid coverage . If you or your dependent(s) become eligible to receive premium assistance under a state CHIP or Medicaid, you may be able to enroll yourself and your dependents . However, you must request enrollment within 60 days of the determination of eligibility for premium assistance from state CHIP or Medicaid . To request special enrollment or obtain more information, contact : Human Resources 930 Winter Street , Suite 1500 Waltham , MA 02451