Common use of Loss of Other Coverage Clause in Contracts

Loss of Other Coverage. A loss of coverage due to an individual’s failure to pay Premiums on a timely basis (including COBRA Premiums), or termination of coverage for cause (fraud or intentional misrepresentation of material fact), will not trigger a special enrollment period. i. If you lose coverage due to any of the following triggering events, you and your eligible dependents can apply for coverage within 60 days after the date of the triggering event. If you apply and are enrolled by the 15th of the month, your new coverage will be effective on the first day of the following month. If you apply and are enrolled between the 16th and the last day of the month, your new coverage will be effective on the first day of the second following month. 1) termination of employment or reduction in hours of employment; 2) termination of employer Premium contributions; 3) change in dependent status due to divorce, annulment or the death of a covered employee whose employment afforded dependent coverage; 4) relocation out of an HMO service area (you must provide proof of having minimum essential coverage, as defined by the Affordable Care Act (ACA), for one or more days during the 60 days immediately preceding the date of the move);

Loss of Other Coverage. A loss of coverage due to an individual’s failure to pay Premiums on a timely basis (including COBRA Premiums), or termination of coverage for cause (fraud or intentional misrepresentation of material fact), will not trigger a special enrollment period. i. If you lose coverage due to any of the following triggering events, you and your eligible dependents can apply for coverage within 60 days after the date of the triggering event. If you apply and are enrolled by the 15th of the month, your new coverage will be effective on the first day of the following month. If you apply and are enrolled between the 16th and the last day of the month, your new coverage will be effective on the first day of the second following month. 1) termination of employment or reduction in hours of employment; 2) termination of employer Premium contributions; 3) change in dependent status due to divorce, annulment or the death of a covered employee whose employment afforded dependent coverage; 4) relocation out of an HMO service area (you must provide proof of having minimum essential coverage, as defined by the Affordable Care Act (ACA), for one or more days during the 60 days immediately preceding the date of the move);