Termination for Ineligibility. 1. The Member is no longer a Qualified Individual eligible to enroll in a Qualified Health Plan through the Exchange. If the Subscriber is no longer eligible for coverage under this Agreement, the Agreement will be terminated. Any Dependents of the terminated Subscriber who remain eligible to enroll in a Qualified Health Plan through the Exchange may do so. 2. A Dependent is no longer eligible for coverage as a Dependent due to a change in the Dependent’s age, status or relationship to the Subscriber. 3. The Effective Date of Termination. a) Under Sections 4.2A.1 and 4.2A.2, the effective date of termination will be the last day of the month that the Member is no longer eligible for coverage unless otherwise instructed by the Exchange, except when a Dependent is no longer eligible for coverage under this Agreement due to reaching the Limiting Age. The Member, as applicable, may request an earlier termination date as provided in Section 4.1 b) When a Dependent is no longer eligible due to reaching the Limiting Age, the effective date of termination will be December 31 of the Calendar Year in which the Dependent reaches the Limiting Age, unless otherwise instructed by the Exchange. 4. The Subscriber is responsible for notifying the Exchange of any changes in the status of a Member as a Qualified Individual or his or her eligibility for coverage, except when the Dependent Child reaches the Limiting Age. These changes include a death or divorce. If the Subscriber knows of a Member’s ineligibility for coverage and intentionally fails to notify the Exchange, CareFirst has the right to seek Rescission of the coverage of the Member or the Agreement under Section 4.3 as of the initial date of the Member’s ineligibility. In such a case, CareFirst has the right to recover the full value of the services and benefits provided during the period of the Member’s ineligibility. CareFirst can recover these amounts from the Subscriber and/or any terminated Member, at the option of CareFirst, less any Premium paid for the Member’s enrollment during the period of ineligibility.
Appears in 5 contracts
Samples: Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Termination for Ineligibility. 1. The Member is no longer a Qualified Individual eligible to enroll in a Qualified Health Plan through the Exchange. If the Subscriber is no longer eligible for coverage under this Agreement, the Agreement will be terminated. Any Dependents of the terminated Subscriber who remain eligible to enroll in a Qualified Health Plan through the Exchange may do so.
2. A Dependent is no longer eligible for coverage as a Dependent due to a change in the Dependent’s age, status or relationship to the Subscriber.
3. The Effective Date of Termination.
a) Under Sections 4.2A.1 and 4.2A.2, the effective date of termination will be the last day of the month that the Member is no longer eligible for coverage unless otherwise instructed by the Exchange, except when a Dependent is no longer eligible for coverage under this Agreement due to reaching the Limiting Age. The Member, as applicable, may request an earlier termination date as provided in Section 4.1
b) When a Dependent is no longer eligible due to reaching the Limiting Age, the effective date of termination will be December 31 of the Calendar Year in which the Dependent reaches the Limiting Age, unless otherwise instructed by the Exchange.
4. The Subscriber is responsible for notifying the Exchange of any changes in the status of a Member as a Qualified Individual or his or her eligibility for coverage, except when the Dependent Child reaches the Limiting Age. These changes include a death or divorce. If the Subscriber knows of a Member’s ineligibility for coverage and intentionally fails to notify the Exchange, CareFirst BlueChoice has the right to seek Rescission of the coverage of the Member or the Agreement under Section 4.3 as of the initial date of the Member’s ineligibility. In such a case, CareFirst BlueChoice has the right to recover the full value of the services and benefits provided during the period of the Member’s ineligibility. CareFirst BlueChoice can recover these amounts from the Subscriber and/or from any terminated Member, less any Premium paid for the Member’s enrollment during the period of ineligibility at the option of CareFirstCareFirst BlueChoice, less any Premium paid for the Member’s enrollment during the period of ineligibility.
Appears in 5 contracts
Samples: Individual Enrollment Agreement, Individual Enrollment Agreement, Individual Enrollment Agreement
Termination for Ineligibility. 1. The Member is no longer a Qualified Individual eligible to enroll in a Qualified Health Plan through the Exchange. If the Subscriber is no longer eligible for coverage under this Agreement, the Agreement will be terminated. Any Dependents of the terminated Subscriber who remain eligible to enroll in a Qualified Health Plan through the Exchange may do so.
2. A Dependent is no longer eligible for coverage as a Dependent due to a change in the Dependent’s age, status or relationship to the Subscriber.
3. The Effective Date of Termination.
a) Under Sections 4.2A.1 and 4.2A.2, the effective date of termination will be the last day of the month that the Member is no longer eligible for coverage unless otherwise instructed by the Exchange, except when a Dependent is no longer eligible for coverage under this Agreement due to reaching the Limiting Age. The Member, as applicable, may request an earlier termination date as provided in Section 4.1
b) When a Dependent is no longer eligible due to reaching the Limiting Age, the effective date of termination will be December 31 of the Calendar Year in which the Dependent reaches the Limiting Age, unless otherwise instructed by the Exchange.unless
4. The Subscriber is responsible for notifying the Exchange of any changes in the status of a Member as a Qualified Individual or his or her eligibility for coverage, except when the Dependent Child reaches the Limiting Age. These changes include a death or divorce. If the Subscriber knows of a Member’s ineligibility for coverage and intentionally fails to notify the Exchange, CareFirst has the right to seek Rescission of the coverage of the Member or the Agreement under Section 4.3 as of the initial date of the Member’s ineligibility. In such a case, CareFirst has the right to recover the full value of the services and benefits provided during the period of the Member’s ineligibility. CareFirst can recover these amounts from the Subscriber and/or any terminated Member, at the option of CareFirst, less any Premium paid for the Member’s enrollment during the period of ineligibility.
Appears in 4 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
Termination for Ineligibility. 1. The Member is no longer a Qualified Individual eligible to enroll in a Qualified Health Plan through the Exchange. If the Subscriber is no longer eligible for coverage under this Agreement, the Agreement will be terminated. Any Dependents of the terminated Subscriber who remain eligible to enroll in a Qualified Health Plan through the Exchange may do so.
2. The Member no longer meets the eligibility requirements stated in Section 2.1C because, at the beginning of a Calendar Year:
a) The Member is over the age of thirty (30); or
b) The Member has not received a certificate of exemption from the Exchange for the reasons identified Section 1302(e)(2)(B)(i) or (ii) of the Affordable Care Act.
3. A Dependent is no longer eligible for coverage as a Dependent due to a change in the Dependent’s age, status or relationship to the Subscriber.
34. The Effective Date of Termination.
a) Under Sections 4.2A.1 and 4.2A.2, the effective date of termination will be the last day of the month that the Member is no longer eligible for coverage unless otherwise instructed by the Exchange, except when a Dependent is no longer eligible for coverage under this Agreement due to reaching the Limiting Age. The Member, as applicable, may request an earlier termination date as provided in Section 4.1
b) When a Dependent is no longer eligible due to reaching the Limiting Age, the effective date of termination will be December 31 of the Calendar Year in which the Dependent reaches the Limiting Age, unless otherwise instructed by the Exchange.
45. The Subscriber is responsible for notifying the Exchange of any changes in the status of a Member as a Qualified Individual or his or her eligibility for coverage, except when the Dependent Child reaches the Limiting Age. These changes include a death or divorce. If the Subscriber knows of a Member’s ineligibility for coverage and intentionally fails to notify the Exchange, CareFirst BlueChoice has the right to seek Rescission of the coverage of the Member or the Agreement under Section 4.3 as of the initial date of the Member’s ineligibility. In such a case, CareFirst BlueChoice has the right to recover the full value of the services and benefits provided during the period of the Member’s ineligibility. CareFirst BlueChoice can recover these amounts from the Subscriber and/or from any terminated Member, less any Premium paid for the Member’s enrollment during the period of ineligibility at the option of CareFirstCareFirst BlueChoice, less any Premium paid for the Member’s enrollment during the period of ineligibility.. SAMPLE
Appears in 3 contracts
Samples: Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
