Termination by Aetna Clause Samples
Termination by Aetna. We may terminate the policy and all coverage it provides under the following conditions: • If you, your agent, or a covered person perform any act or practice that constitutes fraud or if you, your agent, or a covered person make any misrepresentation of, or any omission of, a material fact relevant to the coverage, we may cancel the policy and all coverage it provides, either prospectively or retroactively to the date the fraudulent event occurred or back to the effective date if the event occurred prior to the effective date. See the Fraud, deception, or misrepresentation section. • If a claims administrator, network provider, or vendor is added, canceled, or changed without our prior written consent, we may terminate the policy as of the date of the change in claims administrator, network provider, or vendor. • If the plan is changed and we have not agreed in advance and in writing to continue the policy, we may terminate the policy as of the date and time the plan change is effective. • If you fail to pay claims under the plan or make available funds to pay claims as required by the plan, we may terminate the policy as of the first day that you failed to fund claims. • If you fail to meet the underwriting requirements we have established in our current underwriting guidelines, including any applicable participation or contribution requirements, or fail to have a minimum 51 eligible employees or covered units under the plan, we may terminate the policy as of the first day of the first month when the underwriting requirement was not met. • If you do not comply with or fail to meet your obligations under any material terms and conditions of the policy, including, but not limited to, providing required reports or other information we have reasonably requested from you that is related to our administration of the policy, we may terminate the policy as of the date you failed to comply. • If you suspend active business operations, become insolvent, or are placed in bankruptcy or receivership, we may terminate the policy as of the date any of these occur. • If there is any change in federal or state law or regulation that materially impacts this policy or the coverage provided, we may terminate the policy effective on the date the change in the law is effective. • If you are an employer group and cease to be a group as defined under applicable state law, we may terminate the policy as of the date you no longer qualify as an employer group. We require you tell ...
Termination by Aetna. An individual Member’s coverage under this Group Agreement may be terminated by Aetna in compliance with Mandates if all Member Premiums are not received by Aetna from that Member within 3 months following the Premium Due Date (the “Member Grace Period”). If the Contract Holder has not paid all Contract Holder Premiums within 30 days following the Premium Due Date (the “Contract ▇▇▇▇▇▇ ▇▇▇▇▇ Period”), Aetna may terminate the Group Agreement immediately upon notice to Contract Holder. This Group Agreement may also be terminated by Aetna as follows: ● Upon 30 days written notice to the Contract Holder if the Member Premiums owed by ten percent or more of Members remain unpaid at the end of the applicable Member Grace Period; ● Immediately upon notice to the Contract Holder if the Contract ▇▇▇▇▇▇ has committed fraud or any intentional misrepresentation of a material fact relevant to the coverage provided under this Group Agreement; ● Effective upon any anniversary of the Effective Date if Aetna will no longer offer any of the products most recently offered to Contract Holder in any Service Areas covered under this Group Agreement, because: (1) CMS terminates or otherwise non-renews the Aetna’s CMS Contract, or (2) Aetna terminates its CMS Contract or reduce the Service Areas referenced in Aetna’s CMS Contract; ● Immediately upon notice to the Contract Holder if the Contract Holder no longer has any Member under the Plan(s) who resides in the Service Area; ● Upon 30 days’ written notice to the Contract Holder if the Contract Holder (i) breaches a provision of this Group Agreement and such breach remains uncured at the end of the notice period; (ii) fails to meet Aetna’s contribution or participation requirements applicable to this Group Agreement as set forth in the applicable Financial Document; (iii) provides 30 days’ written notice to Members stating that coverage under this Group Agreement will no longer be provided to Members; (iv) changes its eligibility or participation requirements without Aetna’s consent; or (v) ceases to meet any Mandates applicable to offering the Plan(s), including the Service Area Extension Mandates described in the CMS/Regulatory Compliance Addendum, if applicable; ● Upon 60 days’ written notice to the Contract Holder (or such shorter notice as may be permitted by ▇▇▇▇▇▇▇▇, but in no event less than 30 days) if Aetna ceases to offer a product or coverage in any market in which Members covered under this Group Agreement reside; ● ...