Common use of When Your Coverage Ends When We End Clause in Contracts

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI due to the fraud. BCBSRI may decline reinstatement of your coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreement); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is membership fees due are not paid (see Section 1.13 - Premium 1.5 -Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; . • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your Plans for Individuals & Families coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s provider ‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. If we, for one of the reasons listed above, terminate this agreement, we must send to you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why the agreement ended. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreementabove); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: •  on the date the premium is membership fees due are not paid (see Section 1.13 - Premium 1.5 -Premium and Grace Period); •  the first day of the month following that month in which you cease to be an eligible person; •  the first day of the month your dependent no longer qualifies as an eligible dependent; •  the first day of the month following that month in which you are no longer a Rhode Island resident; •  if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; •  the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your Plans for Individuals & Families coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from the HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: •  only has a prospective effect (as described in the sub-section above When We End This Agreementabove); or •  applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: •  on the date the premium is membership fees due are not paid (see Section 1.13 - Premium 1.5 -Premium and Grace Period); •  the first day of the month following that month in which you cease to be an eligible person; •  the first day of the month your dependent no longer qualifies as an eligible dependent; •  the first day of the month following that month in which you are no longer a Rhode Island resident; •  if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; •  the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your Plans for Individuals & Families coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or •  the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: •  abusive or disruptive behavior in a provider‘s provider ‘s office; •  repeated refusals by a member to accept procedures or treatment recommended by a provider; and •  impairing the ability of the provider to provide care. If you purchase coverage from the HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: •  only has a prospective effect (as described in the sub-section above When We End This Agreementabove); or •  applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is membership fees due are not paid (see Section 1.13 - Premium 1.5 -Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your Plans for Individuals & Families coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s provider ‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from the HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreementabove); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end:  if you leave your place of work;  if you decide to discontinue coverage. We must receive your notice to end automatically: • on this agreement prior to the requested date of cancellation. If we do not receive your notice prior to the requested date of cancellation, you or your employer may be responsible for paying another month’s membership fees;  if you or your employer does not pay any required membership fees within thirty-one (31) days of the date they are due. If your employer does not pay the premium is not paid required fees, the termination will be effective five (see Section 1.13 - Premium and Grace Period)5) days after we mail you a notice of discontinuance; • the first day of the month following that month in which  if you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; •  if we cease to offer this type of coverage;  if your employer contracts with another insurer or entity to provide or administer benefits for the covered health care services provided by this agreement, per the rights and limitations of Rhode Island General Law §27-18.5-4your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; • the date  if fraud is identifieddetermined by us. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and any intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your group coverage. We may decline enrollment in , or any other coverages we offer coverage that may become available in the future. This agreement will end for a covered dependent if the dependent no longer qualifies as an eligible dependent. If this agreement terminates for one of the reasons listed above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why this agreement ended. When your coverage ends, as well; you will be entitled to apply for direct pay membership from Blue Cross & Blue Shield of Rhode Island or • through HealthSource RI. You must meet the eligibility requirements. We must receive an application and membership fees within sixty (60) days from the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide careyour group membership ends. If you purchase do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage from HealthSource RI and through an insurance company in the Qualified Health Plan is terminated or decertified, coverage under this agreement will endstate in which you reside. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: •  only has a prospective effect (as described in the sub-section above When We End This Agreementabove); or •  applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.. We may rescind your coverage if you or your dependents commit fraud. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) or intentional misrepresentation of material fact. Any benefit paid in the past will be voided. You will be responsible to reimburse us for all costs and claims paid. We must provide you a written notice of a rescission at least 30 days in advance. This notice will provide you the opportunity to appeal this decision. Please see Section

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI due to the fraud. BCBSRI may decline reinstatement of your coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s provider ‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreement); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automaticallyend: • on if you leave your place of work; • if you decide to discontinue coverage. We must receive your notice to end this agreement prior to the requested date of cancellation. If we do not receive your notice prior to the requested date of cancellation, you or your employer may be responsible for paying another month’s membership fees; • if you or your employer does not pay any required membership fees within thirty-one (31) days of the date they are due. If your employer does not pay the premium is not paid required fees, the termination will be effective five (see Section 1.13 - Premium and Grace Period)5) days after we mail you a notice of discontinuance; • the first day of the month following that month in which if you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • if your employer contracts with another insurer or entity to provide or administer benefits for the date covered health care services provided by this agreement, your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; • if fraud is identifieddetermined by us. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and any intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your group coverage. We may decline enrollment in , or any other coverages we offer coverage that may become available in the future. This agreement will end for a covered dependent if the dependent no longer qualifies as an eligible dependent. If this agreement terminates for one of the reasons listed above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why this agreement ended. When your coverage ends, as well; you will be entitled to apply for direct pay membership from Blue Cross & Blue Shield of Rhode Island or • through HealthSource RI. You must meet the eligibility requirements. We must receive an application and membership fees within sixty (60) days from the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide careyour group membership ends. If you purchase do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage from HealthSource RI and through an insurance company in the Qualified Health Plan is terminated or decertified, coverage under this agreement will endstate in which you reside. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreementabove); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.. We may rescind your coverage if you or your dependents commit fraud. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) or intentional misrepresentation of material fact. Any benefit paid in the past will be voided. You will be responsible to reimburse us for all costs and claims paid. We must provide you a written notice of a rescission at least 30 days in advance. This notice will provide you the opportunity to appeal this decision. Please see Section

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end:  if you leave your place of work;  if you decide to discontinue coverage. We must receive your notice to end automatically: • on this agreement prior to the requested date of cancellation. If we do not receive your notice prior to the requested date of cancellation, you or your employer/agent may be responsible for paying another month’s membership fees;  if you or your employer/agent does not pay any required membership fees within thirty-one (31) days of the date they are due. If your employer/agent does not pay the premium is not paid required fees, the termination will be effective five (see Section 1.13 - Premium and Grace Period)5) days after we mail you a notice of discontinuance; • the first day of the month following that month in which  if you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; •  if we cease to offer this type of coverage;  if your employer/agent contracts with another insurer or entity to provide or administer benefits for the covered health care services provided by this agreement, per the rights and limitations of Rhode Island General Law §27-18.5-4your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; • the date  if fraud is identifieddetermined by us. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and any intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your group coverage. We may decline enrollment in , or any other coverages we offer coverage that may become available in the future, as well. You will NOT be offered membership in our direct pay plan; or • the date  if abuse or disregard for provider protocols and policies is identified determined by us. If after making a reasonable effort the provider is physicians are unable to establish or keep maintain a satisfactory relationship with a member, coverage may end be terminated after thirty31-one (31) days’ written notice. Examples of unsatisfactory provider and physician-patient relationships include: •  abusive or disruptive behavior in a provider‘s physician’s office; •  repeated refusals by a member to accept procedures or treatment recommended by a providerphysician; and •  impairing the ability of the provider physician to provide care. You will NOT be offered membership in our direct pay plan. This agreement will end for a covered dependent if the dependent no longer qualifies as an eligible dependent. If this agreement terminates for one of the reasons listed above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and membership fees within sixty (60) days from the date your group membership ends. If you purchase do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described through an insurance company in the sub-section above state in which you reside. HIPAA certificate of creditable coverage When your coverage ends, we will send to you a Health Insurance Portability and Accountability Act (HIPAA) certificate of creditable coverage to provide evidence of your prior health coverage. The information in the certificate lets your new health plan know how long you have had coverage, so you can receive credit for it. This information may help you obtain a special enrollment under a new plan. We End This Agreement); or • applies retroactively will also send to the extent that such cancellation is due to the failure to timely pay premiumsyou a HIPAA certificate of creditable coverage upon request.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end:  if you leave your place of work;  if you decide to discontinue coverage. We must receive your notice to end automatically: • on this agreement prior to the requested date of cancellation. If we do not receive your notice prior to the requested date of cancellation, you or your employer/agent may be responsible for paying another month’s membership fees;  if you or your employer/agent does not pay any required membership fees within thirty-one (31) days of the date they are due. If your employer/agent does not pay the premium is not paid required fees, the termination will be effective five (see Section 1.13 - Premium and Grace Period)5) days after we mail you a notice of discontinuance; • the first day of the month following that month in which  if you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; •  if we cease to offer this type of coverage;  if your employer/agent contracts with another insurer or entity to provide or administer benefits for the covered health care services provided by this agreement, per the rights and limitations of Rhode Island General Law §27-18.5-4your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; • the date  if fraud is identifieddetermined by us. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and any intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your group coverage. We may decline enrollment in , or any other coverages we offer coverage that may become available in the future, as well. You will NOT be offered membership in our direct pay plan; or • the date  if abuse or disregard for provider protocols and policies is identified determined by us. If after making a reasonable effort the provider is physicians are unable to establish or keep maintain a satisfactory relationship with a member, coverage may end be terminated after thirty31-one (31) days’ written notice. Examples of unsatisfactory provider and physician-patient relationships include: •  abusive or disruptive behavior in a provider‘s physician’s office; •  repeated refusals by a member to accept procedures or treatment recommended by a providerphysician; and •  impairing the ability of the provider physician to provide care. You will NOT be offered membership in our direct pay plan. This agreement will end for a covered dependent if the dependent no longer qualifies as an eligible dependent. If this agreement terminates for one of the reasons listed above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why this plan ended. When your coverage ends, you will be entitled to apply for direct pay membership from Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and membership fees within sixty (60) days from the date your group membership ends. If you purchase do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described through an insurance company in the sub-section above state in which you reside. HIPAA certificate of creditable coverage When your coverage ends, we will send to you a Health Insurance Portability and Accountability Act (HIPAA) certificate of creditable coverage to provide evidence of your prior health coverage. The information in the certificate lets your new health plan know how long you have had coverage, so you can receive credit for it. This information may help you obtain a special enrollment under a new plan. We End This Agreement); or • applies retroactively will also send to the extent that such cancellation is due to the failure to timely pay premiumsyou a HIPAA certificate of creditable coverage upon request.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI due to the fraud. BCBSRI may decline reinstatement of your coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s provider ‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreement); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.. We may rescind your coverage if you or your dependents commit fraud. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) or intentional misrepresentation of material fact. Any benefit paid in the past will be voided. You will be responsible to reimburse us for all costs and claims paid by us. We must provide you a written notice of a rescission

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is not paid (see Section 1.13 1.14 - Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI due to the fraud. BCBSRI may decline reinstatement of your coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreement); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end automatically: • on the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • the first day of the month following that month in which you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; • if we cease to offer this type of coverage, per the rights and limitations of Rhode Island General Law §27-18.5-4; • the date fraud is identified. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI due to the fraud. BCBSRI may decline reinstatement of your coverage. We may decline enrollment in any other coverages we offer that may become available in the future, as well; or • the date abuse or disregard for provider protocols and policies is identified by us. If after making a reasonable effort the provider is unable to establish or keep a satisfactory relationship with a member, coverage may end after thirty-one (31) days’ written notice. Examples of unsatisfactory provider and patient relationships include: • abusive or disruptive behavior in a provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a provider; and • impairing the ability of the provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described in the sub-section above When We End This Agreement); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums.

When Your Coverage Ends When We End. This Agreement Coverage under this agreement is guaranteed renewable. It can be canceled for the following reasons. This agreement will end:  if you leave your place of work;  if you no longer live or work in the BlueCHiP service area;  if you decide to discontinue coverage. We must receive your notice to end automatically: • on this agreement prior to the requested date of cancellation. If we do not receive your notice prior to the requested date of cancellation, you or your employer/agent may be responsible for paying another month’s membership fees;  if you or your employer/agent does not pay any required membership fees within thirty-one (31) days of the date they are due. If your employer/agent does not pay the premium is not paid required fees, the termination will be effective five (see Section 1.13 - Premium and Grace Period)5) days after we mail you a notice of discontinuance; • the first day of the month following that month in which  if you cease to be an eligible person; • the first day of the month your dependent no longer qualifies as an eligible dependent; • the first day of the month following that month in which you are no longer a Rhode Island resident; •  if we cease to offer this type of coverage;  if your employer/agent contracts with another insurer or entity to provide or administer benefits for the covered health care services provided by this agreement, per the rights and limitations of Rhode Island General Law §27-18.5-4your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; • the date  if fraud is identifieddetermined by us. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and any intentional misrepresentation of a material fact made by you, or on your behalf, that affects your coverage. Fraud may result in retroactive termination. You will be responsible for all costs incurred by BCBSRI Blue Cross & Blue Shield of Rhode Island due to the fraud. BCBSRI Blue Cross & Blue Shield of Rhode Island may decline reinstatement of under your group coverage. We may decline enrollment in , or any other coverages we offer coverage that may become available in the future, as well. You will NOT be offered membership in our direct pay plan; or • the date  if abuse or disregard for provider protocols and policies is identified determined by us. If after making a reasonable effort the provider is physicians are unable to establish or keep maintain a satisfactory relationship with a member, coverage may end be terminated after thirty31-one (31) days’ written notice. Examples of unsatisfactory provider and physician-patient relationships include: •  abusive or disruptive behavior in a provider‘s physician’s office; •  repeated refusals by a member to accept procedures or treatment recommended by a providerphysician; and •  impairing the ability of the provider physician to provide care. You will NOT be offered membership in our direct pay plan. This agreement will end for a covered dependent if the dependent no longer qualifies as an eligible dependent. If this agreement terminates for one of the reasons listed above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and membership fees within sixty (60) days from the date your group membership ends. If you purchase do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this agreement will end. Retroactive Cancellations Rescind/Rescission means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described through an insurance company in the sub-section above state in which you reside. HIPAA certificate of creditable coverage When your coverage ends, we will send to you a Health Insurance Portability and Accountability Act (HIPAA) certificate of creditable coverage to provide evidence of your prior health coverage. This information may help you obtain a special enrollment under a new plan. We End This Agreement); or • applies retroactively will also send to the extent that such cancellation is due you a HIPAA certificate of creditable coverage upon request. We will also send to the failure to timely pay premiumsyou a HIPAA certificate of creditable coverage upon request.