Common use of Loss of Other Coverage Clause in Contracts

Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; and (3) You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) termination of employment; (b) a reduction in the number of hours of employment; (c) termination of Your Prior Health Benefit Plan coverage; (d) You or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area of the health maintenance organization and no other benefit option being available; (g) termination of contribution toward the Premium made by the former employer; (h) Dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent child under the Prior Health Benefit Plan); or (i) expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.

Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-thirty- one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-self funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; and (3) You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) termination of employment; (b) a reduction in the number of hours of employment; (c) termination of Your Prior Health Benefit Plan coverage; (d) You or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area service area of the health maintenance organization and no other benefit option being available; (g) termination of contribution toward the Premium premium made by the former employer; (h) Dependent dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent dependent child under the Prior Health Benefit Plan); or (i) expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.

Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-self funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; and (3) You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) termination of employment; (b) a reduction in the number of hours of employment; (c) termination of Your Prior Health Benefit Plan coverage; (d) You or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area service area of the health maintenance organization and no other benefit option being available; (g) termination of contribution toward the Premium premium made by the former employer; (h) Dependent dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent dependent child under the Prior Health Benefit Plan); or (i) expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.

Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) . You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) . You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; and (3) . You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) a. termination of employment; (b) b. a reduction in the number of hours of employment; (c) c. termination of Your Prior Health Benefit Plan coverage; (d) You x. Xxx or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) e. the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) f. if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area of the health maintenance organization and no other benefit option being available; (g) g. termination of contribution toward the Premium made by the former employer; (h) h. Dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent child under the Prior Health Benefit Plan); or (i) i. expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.

Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-one thirty‐one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-self funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; and (3) You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) termination of employment; (b) a reduction in the number of hours of employment; (c) termination of Your Prior Health Benefit Plan coverage; (d) You or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area service area of the health maintenance organization and no other benefit option being available; (g) termination of contribution toward the Premium premium made by the former employer; (h) Dependent dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent dependent child under the Prior Health Benefit Plan); or (i) expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.

Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-thirty- one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-self funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; andand Sample (3) You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) termination of employment; (b) a reduction in the number of hours of employment; (c) termination of Your Prior Health Benefit Plan coverage; (d) You or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area service area of the health maintenance organization and no other benefit option being available; (g) termination of contribution toward the Premium premium made by the former employer; (h) Dependent dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent dependent child under the Prior Health Benefit Plan); or (i) expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.