Rescission of Enrollment for Fraud or Misrepresentation. This Agreement, or the enrollment of a Member, may be Rescinded if: A. The Member has performed an act, practice, or omission that constitutes fraud; B. The Member has made an intentional misrepresentation of material fact; or C. An act, practice or omission that constitutes fraud includes, but is not limited to, fraudulent use of CareFirst’s identification card by the Member, the alteration or sale of prescriptions by the Member, or an attempt by a Subscriber to enroll non-eligible persons. D. CareFirst demonstrates, to the reasonable satisfaction of the Exchange, if required by the Exchange, that the rescission is appropriate. CareFirst will provide thirty (30) days advance written notice of any Rescission. CareFirst shall have the burden of persuasion that its Rescission complies with applicable local law. The Rescission shall either (i) void the enrollment of the Member as of the Member’s Effective Date (for fraudulent acts, practices, or omissions that occur at the time of enrollment); or (ii) in all other cases, void the enrollment of the Member as of the first date the Member performed an act, practice or omission that constituted fraud or made an intentional misrepresentation of material fact. The Subscriber will be responsible for payment of any voided benefits paid by CareFirst, net of applicable Premiums paid.
Appears in 5 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Rescission of Enrollment for Fraud or Misrepresentation. This Agreement, or the enrollment of a Member, may be Rescinded if:
A. The Member has performed an act, practice, or omission that constitutes fraud;
B. The Member has made an intentional misrepresentation of material fact; or
C. An act, practice or omission that constitutes fraud includes, but is not limited to, fraudulent use of CareFirst’s identification card by the Member, the alteration or sale of prescriptions by the Member, or an attempt by a Subscriber to enroll non-eligible persons.
D. CareFirst demonstrates, to the reasonable satisfaction of the Exchange, if required by the Exchange, that the rescission is appropriate. SAMPLE CareFirst will provide thirty (30) days advance written notice of any Rescission. CareFirst shall have the burden of persuasion that its Rescission complies with applicable local law. The Rescission shall either (i) void the enrollment of the Member as of the Member’s Effective Date (for fraudulent acts, practices, or omissions that occur at the time of enrollment); or (ii) in all other cases, void the enrollment of the Member as of the first date the Member performed an act, practice or omission that constituted fraud or made an intentional misrepresentation of material fact. The Subscriber will be responsible for payment of any voided benefits paid by CareFirst, net of applicable Premiums paid.
Appears in 4 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan
