Common use of General Rules for Enrollment Clause in Contracts

General Rules for Enrollment. a. All factual representations made by you, in connection with enrollment for coverage in the Plan and the issuance of this Contract, must be accurate and complete. Any false or intentionally misleading information provided during the enrollment process or at any other time may result, in addition to any other legal rights we may have, in disqualification for, termination of, or rescission of coverage. b. Fraud or intentional misrepresentation of material fact, omissions, concealment of facts, and incorrect statements made by you, or your Covered Dependents, which are discovered by us or the Marketplace, may prevent payment of benefits under this Contract, may void this Contract, and may cause Claims to be denied for the individual making, or the subject of, the misrepresentation, omission, concealment of facts or incorrect statement. Fraudulent misstatements discovered by us or the Marketplace, at any time, may result in this Contract being voided or Claims being denied for the individual making or responsible for the fraudulent misstatement. Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of Claim or an application containing any false, incomplete or misleading information is guilty of a felony, punishable as provided by Florida Statutes. c. We will not provide coverage and benefits to any individual who would not have been entitled to enrollment with us had accurate and complete information been provided to us, or the Marketplace if applicable, on a timely basis. In such cases we may require you or an individual legally responsible for you, to reimburse us for any payments we made on your behalf. If a Member or applicant fails to provide accurate information which AvMed deems material then, upon ten days written notice, AvMed may deny membership to such individual. d. If, in applying for this Contract or in enrolling yourself or your dependents, you make a fraudulent statement or misrepresentation pertaining to information such as your geographical area, gender, age, or the gender and/or age of your dependents, our sole liability will be the return of any unearned Premium, less benefit payments. However, at our discretion, we may elect to cancel the Contract with forty-five days’ prior written notice; or continue this Contract if, upon 30 days’ written notice from us, you make payment to us for the full amount of the Premium which would have been in effect had you stated the true facts. e. Eligible individuals may enroll in the Plan with us, or through the Marketplace at XxxxxxXxxx.xxx. The Marketplace follows enrollment rules specified by the Federal Government and the State of Florida. These enrollment rules may or may not apply if you enroll in the Plan directly with us. If you enroll in the Plan through the Marketplace, you may be eligible for tax credits to help pay for your cost of coverage. The following sections discuss the rules and benefits of enrollment through the Marketplace.

General Rules for Enrollment. a. All factual representations made by you, in connection with enrollment for coverage in the Plan and the issuance of this Contract, must be accurate and complete. Any false or intentionally misleading information provided during the enrollment process or at any other time may result, in addition to any other legal rights we may have, in disqualification for, termination of, or rescission of coverage. b. Fraud or intentional misrepresentation of material fact, omissions, concealment of facts, and incorrect statements made by you, or your Covered Dependents, which are discovered by us or the Marketplace, may prevent payment of benefits under this Contract, may void this Contract, and may cause Claims to be denied for the individual making, or the subject of, the misrepresentation, omission, concealment of facts or incorrect statement. Fraudulent misstatements discovered by us or the Marketplace, at any time, may result in this Contract being voided or Claims being denied for the individual making or responsible for the fraudulent misstatement. Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of Claim or an application containing any false, incomplete or misleading information is guilty of a felony, punishable as provided by Florida Statutes. c. We will not provide coverage and benefits to any individual who would not have been entitled to enrollment with us had accurate and complete information been provided to us, or the Marketplace if applicable, on a timely basis. In such cases we may require you or an individual legally responsible for you, to reimburse us for any payments we made on your behalf. If a Member or applicant fails to provide accurate information which AvMed deems material then, upon ten days days’ written notice, AvMed may deny membership to such individual. d. If, in applying for this Contract or in enrolling yourself or your dependents, you make a fraudulent statement or misrepresentation pertaining to information such as your geographical area, gender, age, or the gender and/or age of your dependents, our sole liability will be the return of any unearned Premium, less benefit payments. However, at our discretion, we may elect to cancel the Contract with forty-five days’ prior written notice; or continue this Contract if, upon 30 days’ written notice from us, you make payment to us for the full amount of the Premium which would have been in effect had you stated the true facts. e. Eligible individuals may enroll in the Plan with us, or through the Marketplace at XxxxxxXxxx.xxx. The Marketplace follows enrollment rules specified by the Federal Government and the State of Florida. These enrollment rules may or may not apply if you enroll in the Plan directly with us. If you enroll in the Plan through the Marketplace, you may be eligible for tax credits to help pay for your cost of coverage. The following sections discuss the rules and benefits of enrollment through the Marketplace.