When Your Coverage Begins When First Eligible. This agreement goes into effect on the first day of the month for which we accept your application and you have paid the membership fees. This date is your anniversary date. Under this agreement the renewal date is April 1st of each calendar year. This agreement will automatically renew on the renewal date as long as your membership fees are paid, except if one of the events applies from the section below entitled “When Your Coverage Ends”. We accept new subscribers in accordance with Rhode Island General Law §27-18.5-3. You may enroll your eligible dependents on your anniversary date, the renewal date, or during our open enrollment period. If your dependents fail to enroll at this time, they cannot enroll in the plan unless they do so through a Special Enrollment Period. After your initial effective date, you may only enroll your eligible dependents for coverage through a Special Enrollment Period after your dependents experience either a change in family status or a loss of coverage as described below. You must make written application within the thirty-one (31) days following that event. • Change in Family Status: Your eligible dependents will qualify for a Special Enrollment Period if you get married, or have a child born to, or placed for adoption with your family. • Loss of Coverage: Your eligible dependents will qualify for a Special Enrollment Period by loss of coverage if each of the following conditions are met: (a) The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; and (b) The person waived coverage under this plan due to being covered on another (c) The coverage on the other plan is terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or if the coverage was due to COBRA continuation, as a result of such coverage being exhausted. If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b)
Appears in 2 contracts
Samples: Subscriber Agreement, Subscriber Agreement
When Your Coverage Begins When First Eligible. This agreement goes into effect on the first day of the month for which we accept your application and you have paid the membership fees. This date is your anniversary date. Under this agreement agreement, the renewal date is April 1st of each calendar yearOctober 1, 2013. This agreement will automatically renew on the renewal date (October 1, 2013) as long as your membership fees are paid, except . The only exception would be if one of the events applies from the section below entitled “Section 2.4 - When Your Coverage Ends”Ends applies. We accept new subscribers in accordance with Rhode Island General Law §27-18.5-3. You may enroll your eligible dependents on your anniversary date, the renewal date, or during our open enrollment period. If your dependents fail to do not enroll at this time, they cannot your dependent may only enroll if he or she: • completes the Direct Pay Medical Underwriting Addendum form in the plan unless they do so application and our Underwriting Department approves a preferred premium; or • enrolls through a Special Enrollment Period. Contact Customer Service for more information about applying for a preferred premium. After your initial effective date, you may only enroll your eligible dependents for coverage through a Special Enrollment Period after your dependents you experience either a change in family status or status, a loss of coverage private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. You With a change in family status, you must make written application within the thirty-one (31) days following that the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • Change in Family Status: Your if you get married, coverage begins the first day of the month following your marriage; • if you have a child born to the family, coverage begins on the date of the child’s birth; • if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. With a loss of private health coverage, you must make written application within the thirty-one (31) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this plan begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if you get married, or have a child born to, or placed for adoption with your family. • Loss of Coverage: Your eligible dependents will qualify for a Special Enrollment Period by loss of coverage if each of the following conditions are is met:
(a) : • The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; and
(b) • The person waived coverage under this plan due to being covered on another
(c) another plan; and • The coverage on the other plan is terminated as a result of of: o loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), o employer contributions towards such coverage being terminated, or o COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a CHIP, you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage was under this plan begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to COBRA continuationa loss of eligibility; or • you and/or your eligible dependent become eligible for premium assistance, as a result of such coverage being exhaustedunder your employer/agent’s coverage, through Medicaid or CHIP. If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b)) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 2 contracts
Samples: Subscriber Agreement, Subscriber Agreement
