Termination of a Members Coverage. 1. A Member's coverage may be terminated for fraud at any time. A Member’s coverage may be terminated within three (3) years of the Member's Effective Date if material misrepresentation was made in connection with enrollment for coverage.
2. Unless COBRA Continuation of Coverage is available and selected as provided in this Benefit Plan, a Member's coverage terminates as provided below:
a. The Subscriber’s coverage and that of all his Dependents automatically, and without notice, terminates at the end of the period in which the Subscriber ceases to be eligible.
b. The coverage of the Subscriber's Spouse will terminate automatically, and without notice, at the end of the period for which premiums have been paid at the time of the entry of a final decree of divorce or other legal termination of marriage.
c. The coverage of a Dependent will terminate automatically, and without notice, at the end of the month the Dependent ceases to be an eligible Dependent, if premiums have been paid through that month.
d. Upon the death of a Subscriber, the coverage of all of his surviving Dependents will terminate automatically and without notice at the end of the month that death occurred if premiums have been paid through that month. However, a surviving Spouse or Dependent may be able to elect COBRA continuation of coverage as described elsewhere in this Benefit Plan.
3. In the event the Group cancels this Benefit Plan or We terminate this Benefit Plan for nonpayment of the appropriate payment when due or because the Group fails to perform any obligation required by this Benefit Plan, such cancellation or termination alone will operate to end all rights of the Member to Benefits under this Benefit Plan as of the effective date of such cancellation or termination. The Group shall have the obligation to notify its Members, participants, and beneficiaries of such cancellation or termination. We shall have no such obligation of notification at the Member level.
4. Except as otherwise provided in this Benefit Plan, no Benefits are available to a Member for Covered Services rendered after the date of cancellation or termination of a Member's coverage.
5. The Company reserves the right to automatically change the Subscriber’s class of coverage to reflect when no more children or grandchildren are covered under this Benefit Plan.
Termination of a Members Coverage. 1. All coverage will end at the end of the period for which premiums have been paid. No Benefits are available for Covered Services rendered after the date of termination of coverage.
2. Coverage for Subscriber’s Spouse terminates automatically, without notice, at the end of the period for which premiums have been paid, when a final decree of divorce or other legal termination of marriage is rendered.
3. Coverage for Dependents terminates automatically, without notice, at the end of the year the Dependent ceases to be an eligible Dependent, unless it is specifically otherwise stated in this Contract or as provided by law. Premiums are required to be paid in order to retain coverage until the Dependent ceases to be eligible.
4. Upon the death of the Subscriber, all coverage on this Contract ends for all Covered persons on the Contract. Termination is automatic and without notice. Termination is effective at the end of the billing period in which the Subscriber’s death occurred, if premiums have been paid through that billing cycle.
5. In the event of circumstances stated in paragraphs 2, 3, or 4 above, the Spouse or other covered Dependents may elect to continue coverage. The Member must notify Us of the desire to continue coverage. Notification must be received by a Blue Cross and Blue Shield of Louisiana office within thirty (30) days after the date of termination.
6. In the event that You move outside Our Service Area with the intent to relocate or establish a new residence outside Our Service Area, Your coverage will be terminated.
7. We reserve the right to automatically change the class of coverage and charge appropriate premium on this Contract to reflect the membership on the Contract.
Termination of a Members Coverage a. L oss of Eligibility. Subject to the continuation rights described herein:
Termination of a Members Coverage. 1. All coverage will end at the end of the period for which premiums have been paid. No Benefits are available for Covered Services rendered after the date of termination of coverage.
2. Coverage for Subscriber’s Spouse terminates automatically, without notice, at the end of the period for which premiums have been paid, when a final decree of divorce or other legal termination of marriage is rendered.
3. Coverage for Dependents terminates automatically, without notice, at the end of the year the Dependent ceases to be an eligible Dependent, unless it is specifically otherwise stated in this
4. Upon the death of the Subscriber, all coverage on this Contract ends for all Covered persons on the Contract. Termination is automatic and without notice. Termination is effective at the end of the billing period in which the Subscriber’s death occurred, if premiums have been paid through that billing cycle.
5. In the event of circumstances stated in paragraphs 2, 3, or 4 above, the Spouse or other covered Dependents may elect to continue coverage. The Member must notify Us of the desire to continue coverage. Notification must be received by a Blue Cross and Blue Shield of Louisiana office within thirty (30) days after the date of termination.
6. In the event that You move outside Our Service Area with the intent to relocate or establish a new residence outside Our Service Area, Your coverage will be terminated.
7. We reserve the right to automatically change the class of coverage and charge appropriate premium on this Contract to reflect the membership on the Contract.
Termination of a Members Coverage. 12.01 If this Certificate is terminated pursuant to Article X, the Member’s coverage shall terminate at the time specified in Article X without further action of the Plan.
12.02 If a Member ceases to meet the eligibility requirements of the Group Operating Agreement and this Certificate, coverage shall terminate (subject to the conversion rights under Article XIII) only for the reasons outlined as follows:
(a) If the Subscriber or Plan is no longer eligible for coverage through the Health Insurance Marketplace, if applicable.
(b) Coverage shall terminate at the end of the month in which a Dependent child attains the age of twenty-six (26).
(c) In the event a Member transfers residence outside the Service Area, Authorized Benefits, and Services may be terminated.
(d) Coverage shall terminate for the Dependent child if the Dependent child becomes eligible for coverage from their employer.
(e) Member changes Products on the Health Insurance Marketplace.
(f) Member is no longer part of the Group.
12.03 The Plan may rescind a Member’s coverage under this Certificate for intentional misrepresentation of a material fact on the Enrollment Application. Member will be given thirty (30) days advanced written notice of rescission of coverage.
12.04 The Plan may terminate a Member’s coverage for intentionally or fraudulently providing false or misleading information or withholding material information on any required plan form or in applying for or seeking any health care under the terms of this Certificate. Termination of coverage is effective thirty (30) days after notice of termination is given by the Plan.
12.05 The Plan may terminate a Member’s coverage if the Member aids, attempts to aid, or knowingly permits any other person not a Member to obtain benefits or services from or through the Plan. Termination of coverage is effective upon thirty (30) days advanced written notice. Reason for termination will be stated in the letter.
12.06 Members may elect to terminate their coverage during Group Open Enrollment that occurs once a year, or in the event that the Member ceases to meet the eligibility requirements as defined in this document or the Group Operating Agreement, or within the period of no greater than fourteen (14) days, by giving written notice to the Plan and the Remitting Agent and Health Insurance Marketplace, if applicable.
12.07 Benefits for any authorized inpatient admission to a hospital or skilled nursing facility that began prior to the effective ...
Termination of a Members Coverage. All coverage will end at the end of the period for which premiums have been paid. No Benefits are available for Covered Services rendered after the date of termination of coverage. Coverage for Subscriber’s Spouse terminates automatically, without notice, at the end of the period for which premiums have been paid, when a final decree of divorce or other legal termination of marriage is rendered. Coverage for Dependents terminates automatically, without notice, at the end of the year the Dependent ceases to be an eligible Dependent, unless it is specifically otherwise stated in this Contract or as provided by law. Premiums are required to be paid in order to retain coverage until the Dependent ceases to be eligible. Upon the death of the Subscriber, all coverage on this Contract ends for all Covered persons on the Contract. Termination is automatic and without notice. Termination is effective at the end of the billing period in which the Subscriber’s death occurred, if premiums have been paid through that billing cycle. In the event of circumstances stated in paragraphs 2, 3, or 4 above, the Spouse or other covered Dependents may elect to continue coverage. The Member must notify Us of the desire to continue coverage. Notification must be received by a Blue Cross and Blue Shield of Louisiana office within thirty (30) days after the date of termination. We reserve the right to automatically change the class of coverage and charge appropriate premium on this Contract to reflect the membership on the Contract.
Termination of a Members Coverage. A Member, who is not receiving Core LTD Benefits under the Core LTD Program, shall cease to be entitled to coverage for Core LTD Benefits under the Core LTD Program on the earliest of the following dates:
1. One hundred twenty days prior to the last day of the month during which the Member attains the age of sixty-five (65) years;
2. The date the Member no longer meets the definition of Member;
3. The thirty-second (32nd) day of an unpaid leave of absence;
4. The date the Member temporarily occupies a position that is not eligible for coverage in accordance with the definition of Member in Section 1(A) Definitions;
5. The date of the Member’s termination of service; and
6. One hundred twenty days prior to the last day of the month during which the Member attains thirty-five (35) years of pensionable service and a minimum age of fifty-five (55) pursuant to the terms of the Municipal Pension Plan or other school district pension arrangement.
Termination of a Members Coverage. 11.01 The Certificate and the Group Operating Agreement shall continue in effect for one (1) year from the effective date and from year to year thereafter. The Plan may terminate this Certificate and the Group Operating Agreement without notice if the Group fails to pay the Premium within the Grace Period. In the event the Premium is not paid within the Grace Period, this Certificate terminates and all Authorized Benefits and Services cease retroactively as of 11.59 p.m. on the due date, unless otherwise expressly agreed upon by the Plan in writing. In the event of termination, the Plan reserves the right to recover from the Group the costs of services rendered to the Members during the period following the due date and to reject claims submitted by Providers for services rendered during the period following the due date.
Termination of a Members Coverage. 7.01 The Plan will be responsible for the Member’s medical care until the State notifies the Plan that its responsibility for the Member is no longer in effect.
7.02 Coverage for a Member shall terminate whenever any of the following occurs:
(1) The Contract between the Plan and the State is terminated for any reason
(2) The Member is no longer eligible for XXXxxxx and does not regain eligibility within sixty (60) days.
(3) The Member dies.
(4) The Member moves outside the Plan’s service area and the State has disenrolled the member from the plan.
(5) Admission to a correctional facility or an intermediate care facility for the mental retarded (ICF/MR).
(6) Family/Child/Children move from the state.
(7) Member is eligible for Medicaid before annual renewal.
(8) Loss of eligibility.
(9) Other comprehensive health care coverage is obtained.
(10) The Member is eligible for long-term custodial services in a nursing facility following discharge from an acute care inpatient facility, the health plan has requested disenrollment, and the State has approved the disenrollment.
(11) The Member is admitted to a state psychiatric hospital.
(12) Other circumstances where the MIChild Program dictates
7.03 The Plan may request disenrollment of a Member by the State, when actions by the Member are inconsistent with the Plan’s membership, including fraud, waste and abuse of the Plan’s services, or other intentional misconduct; or if, in the opinion of the PCP, the Member’s behavior makes it medically infeasible to safely or prudently render Covered Services. Such termination is subject to the grievance procedures as set forth in this Certificate. The notice of intent to terminate shall be immediately communicated to the Member whose enrollment is requested to be terminated, along with procedures for xpeditious review pursuant to Article 4 Section 7.
Termination of a Members Coverage. 1. All coverage will end at the end of the period for which premiums have been paid. No Benefits are available for Covered Services rendered after the date of termination of coverage.
2. Coverage for Subscriber’s spouse terminates automatically, without notice, at the end of the period for which premiums have been paid, when a final decree of divorce or other legal termination of marriage is rendered.
