Common use of Loss of Coverage Clause in Contracts

Loss of Coverage. An Eligible Employee or Enrolled Employee and/or his/her Dependent(s) who experience a loss of minimum essential coverage (as defined in Section 1345.5 of the California Health and Safety Code or subsection (f) of Section 5000A of the Internal Revenue Code) may enroll in Plan or change benefit plans offered by Employer Group if the loss of coverage is due to one of the following: (1) Exhaustion of COBRA or Cal-COBRA coverage (does not include termination due to failure to pay premiums on a timely basis). (2) Termination of employer-contributions for non-COBRA or non-Cal-COBRA coverage. (3) Loss of eligibility for non-COBRA or non-Cal-COBRA coverage (not including termination for cause or termination for nonpayment of premiums). For example, loss of eligibility may be due to a reduction in hours of employment, termination of employment, moving out of the plan’s service area, a Dependent reaching the limiting age for coverage, death of the Enrolled Employee, or legal separation or divorce. (4) Reaching a lifetime maximum on all benefits. (5) Loss of coverage, including a substantial elimination of benefits, within one year before or after the date of commencement of a bankruptcy proceeding under title 11 of the United States Code, consistent with paragraph (6) of Section 1163 of the United States Code. An Eligible Employee and/or his or her Dependent(s) shall have 30 days from the date of loss of coverage to enroll in Plan, except loss of Medi-Cal or Children’s Health Insurance Program (CHIP) coverage, for which the Eligible Employee and/or his or her Dependent(s) shall have 60 days to enroll. If the employee requests enrollment on or before the last day of coverage, coverage shall be effective as of 12:01 a.m. on the first day of the month following loss of such coverage. Otherwise, coverage will be effective as of 12:01 a.m. on the first day of the month following the month in which the employee requests enrollment in Plan. For example, an Eligible Employee loses his other coverage on March 31. If that Eligible Employee requests enrollment in Plan on or before March 31, his coverage will be effective under this Agreement on April 1. If that Eligible Employee requests enrollment in Plan anytime between April 1 and April 30, his coverage will be effective May 1.