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: • if you leave your place of work; • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if you cease to be an eligible person; • if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if fraud is determined by us. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) and any intentional misrepresentation 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 under your group coverage, or any other coverage that may become available in the future; or • if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: • abusive or disruptive behavior in a physician’s office; • repeated refusals by a member to accept procedures or treatment recommended by a physician; and • impairing the ability of the physician to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this 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. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you 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 endend automatically: • if you leave your place of workon the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 due to the fraud. BCBSRI may decline reinstatement under of your group coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future, as well; or • if the date abuse or disregard for provider protocols and policies is determined identified by us. If after making a reasonable effort physicians are the provider is unable to establish or maintain keep a satisfactory relationship with a member, coverage may be terminated end after thirty-one (31-) days’ written notice. Examples of unsatisfactory physician-provider and patient relationships include: • abusive or disruptive behavior in a physician’s provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a physicianprovider; and • impairing the ability of the physician provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, for one Rescind/Rescission means a cancellation or discontinuance of the reasons listed above, terminate this agreement, we must send to you coverage that has a termination notice thirty retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (30) days before the termination date. The notice will indicate the reason why the agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company as described in the state in which you reside. sub-section above When your coverage ends, we will send We End This Agreement); or • applies retroactively to you a Health Insurance Portability and Accountability Act (HIPAA) certificate of creditable coverage the extent that such cancellation is due 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 will also send failure to you a HIPAA certificate of creditable coverage upon requesttimely 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 endend automatically: • if you leave your place of work on the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if  the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 due to the fraud. BCBSRI may decline reinstatement under of your group coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future, as well; or • if  the date abuse or disregard for provider protocols and policies is determined identified by us. If after making a reasonable effort physicians are the provider is unable to establish or maintain keep a satisfactory relationship with a member, coverage may be terminated end after thirty-one (31-) days’ written notice. Examples of unsatisfactory physician-provider and patient relationships include: •  abusive or disruptive behavior in a physician’s provider‘s office; •  repeated refusals by a member to accept procedures or treatment recommended by a physicianprovider; and •  impairing the ability of the physician provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, for one Rescind/Rescission means a cancellation or discontinuance of the reasons listed above, terminate this agreement, we must send to you coverage that has a termination notice thirty retroactive effect. A cancellation is not a rescission if it:  only has a prospective effect (30) days before the termination date. The notice will indicate the reason why the agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company as described in the state in which you reside. sub-section above When your coverage ends, we will send We End This Agreement); or  applies retroactively to you a Health Insurance Portability and Accountability Act (HIPAA) certificate of creditable coverage the extent that such cancellation is due 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 will also send failure to you a HIPAA certificate of creditable coverage upon requesttimely 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, your employer/agent, or HealthSource RI . We must receive your notice to end this agreement fourteen (14) days 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 employer may be responsible for paying another month’s premiummembership fees; • if you or your employer/agent employer does not pay any required premium membership fees within thirty-one month (31) days of the date they are due. If your employer/agent employer does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if you cease to be an eligible person; • if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • if your employer/agent employer contracts with another insurer or entity to provide or administer benefits for the 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 determined 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 under your group coverage, or any other coverage that may become available in the future; or • . This agreement will end for a covered dependent if abuse or disregard for provider protocols and policies is determined by usthe dependent no longer qualifies as an eligible dependent. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: • abusive or disruptive behavior in a physician’s office; • repeated refusals by a member to accept procedures or treatment recommended by a physician; and • impairing the ability of the physician to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, agreement terminates for one of the reasons listed above, terminate this agreement, we must send to you above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why the this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium membership fees within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. When 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 above); or • applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums. We may rescind your coverage endsif you or your dependents commit fraud. Fraud includes, we 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 send be voided. You will be responsible to reimburse us for all costs and claims paid. We must provide you a Health Insurance Portability and Accountability Act (HIPAA) certificate written notice of creditable coverage to provide evidence of your prior health coverage. The information a rescission at least 30 days in the certificate lets your new health plan know how long you have had coverage so you can receive credit for itadvance. This information may help notice will provide you obtain a special enrollment under a new planthe opportunity to appeal this decision. We will also send to you a HIPAA certificate of creditable coverage upon request.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 endend automatically: • if you leave your place of work on the date membership fees due are not paid (see Section 1.5 -Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if  the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 under your group Plans for Individuals & Families coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future; or • if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: • abusive or disruptive behavior in a physician’s office; • repeated refusals by a member to accept procedures or treatment recommended by a physician; and • impairing the ability of the physician to provide careas well. If you purchase coverage from the HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, for one agreement will end. 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 above); or  applies retroactively to the reasons listed above, terminate this agreement, we must send extent that such cancellation is due to you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why the agreement ended. When your coverage ends, you will be entitled failure to apply for direct timely pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you a HIPAA certificate of creditable coverage upon requestpremiums.

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 endend automatically: • if you leave your place of workon the date membership fees due are not paid (see Section 1.5 -Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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. • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 under your group Plans for Individuals & Families coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future, as well; or • if the date abuse or disregard for provider protocols and policies is determined identified by us. If after making a reasonable effort physicians are the provider is unable to establish or maintain keep a satisfactory relationship with a member, coverage may be terminated end after thirty-one (31-) days’ written notice. Examples of unsatisfactory physician-provider and patient relationships include: • abusive or disruptive behavior in a physician’s provider ‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a physicianprovider; and • impairing the ability of the physician provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this 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. When your Rescind/Rescission means a cancellation or discontinuance of coverage ends, you will be entitled that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described above); or • applies retroactively to apply for direct the extent that such cancellation is due to the failure to timely pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you a HIPAA certificate of creditable coverage upon requestpremiums.

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 endend automatically: • if you leave your place of work on the date membership fees due are not paid (see Section 1.5 -Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if  the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 under your group Plans for Individuals & Families coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future, as well; or • if  the date abuse or disregard for provider protocols and policies is determined identified by us. If after making a reasonable effort physicians are the provider is unable to establish or maintain keep a satisfactory relationship with a member, coverage may be terminated end after thirty-one (31-) days’ written notice. Examples of unsatisfactory physician-provider and patient relationships include: •  abusive or disruptive behavior in a physician’s provider ‘s office; •  repeated refusals by a member to accept procedures or treatment recommended by a physicianprovider; and •  impairing the ability of the physician provider to provide care. If you purchase coverage from the HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, for one agreement will end. 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 above); or  applies retroactively to the reasons listed above, terminate this agreement, we must send extent that such cancellation is due to you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why the agreement ended. When your coverage ends, you will be entitled failure to apply for direct timely pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you a HIPAA certificate of creditable coverage upon requestpremiums.

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 endend automatically: • if you leave your place of workon the date membership fees due are not paid (see Section 1.5 -Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 under your group Plans for Individuals & Families coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future, as well; or • if the date abuse or disregard for provider protocols and policies is determined identified by us. If after making a reasonable effort physicians are the provider is unable to establish or maintain keep a satisfactory relationship with a member, coverage may be terminated end after thirty-one (31-) days’ written notice. Examples of unsatisfactory physician-provider and patient relationships include: • abusive or disruptive behavior in a physician’s provider ‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a physicianprovider; and • impairing the ability of the physician provider to provide care. If you purchase coverage from the HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, for one agreement will end. 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 above); or • applies retroactively to the reasons listed above, terminate this agreement, we must send extent that such cancellation is due to you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why the agreement ended. When your coverage ends, you will be entitled failure to apply for direct timely pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you a HIPAA certificate of creditable coverage upon requestpremiums.

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, your employer/agent, or HealthSource RI . We must receive your notice to end this agreement fourteen (14) days 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 employer may be responsible for paying another month’s premiummembership fees; •  if you or your employer/agent employer does not pay any required premium membership fees within thirty-one month (31) days of the date they are due. If your employer/agent employer does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; •  if you cease to be an eligible person; •  if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; •  if your employer/agent employer contracts with another insurer or entity to provide or administer benefits for the 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 determined 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 under your group coverage, or any other coverage that may become available in the future; or • . This agreement will end for a covered dependent if abuse or disregard for provider protocols and policies is determined by usthe dependent no longer qualifies as an eligible dependent. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: • abusive or disruptive behavior in a physician’s office; • repeated refusals by a member to accept procedures or treatment recommended by a physician; and • impairing the ability of the physician to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, agreement terminates for one of the reasons listed above, terminate this agreement, we must send to you above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why the this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium membership fees within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. When 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 above); or  applies retroactively to the extent that such cancellation is due to the failure to timely pay premiums. We may rescind your coverage endsif you or your dependents commit fraud. Fraud includes, we 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 send be voided. You will be responsible to reimburse us for all costs and claims paid. We must provide you a Health Insurance Portability and Accountability Act (HIPAA) certificate written notice of creditable coverage to provide evidence of your prior health coverage. The information a rescission at least 30 days in the certificate lets your new health plan know how long you have had coverage so you can receive credit for itadvance. This information may help notice will provide you obtain a special enrollment under a new planthe opportunity to appeal this decision. We will also send to you a HIPAA certificate of creditable coverage upon request.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 endend automatically: • if you leave your place of workon the date the premium is not paid (see Section 1.14 - Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 due to the fraud. BCBSRI may decline reinstatement under of your group coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future; or • if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: • abusive or disruptive behavior in a physician’s office; • repeated refusals by a member to accept procedures or treatment recommended by a physician; and • impairing the ability of the physician to provide careas well. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, for one agreement will end. Rescind/Rescission means a cancellation or discontinuance of the reasons listed above, terminate this agreement, we must send to you coverage that has a termination notice thirty retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (30) days before the termination date. The notice will indicate the reason why the agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company as described in the state in which you reside. sub-section above When your coverage ends, we will send We End This • applies retroactively to you a Health Insurance Portability and Accountability Act (HIPAA) certificate of creditable coverage the extent that such cancellation is due 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 will also send failure to you a HIPAA certificate of creditable coverage upon requesttimely 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, your employer/agent, or HealthSource RI . We must receive your notice to end this agreement fourteen (14) days 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 premiummembership fees; •  if you or your employer/agent does not pay any required premium membership fees within thirty-one month (31) days of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; •  if you cease to be an eligible person; •  if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; •  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, your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; •  if fraud is determined 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 under your group coverage, or any other coverage that may become available in the future. You will NOT be offered membership in our direct pay plan; or •  if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: •  abusive or disruptive behavior in a physician’s office; •  repeated refusals by a member to accept procedures or treatment recommended by a physician; and •  impairing the ability of the 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 you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, agreement terminates for one of the reasons listed above, terminate this agreement, we must send to you above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why the this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium membership fees within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you a HIPAA certificate of creditable coverage upon request. We will also send to you 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, your employer/agent, or HealthSource RI . We must receive your notice to end this agreement fourteen (14) days 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 premiummembership fees; •  if you or your employer/agent does not pay any required premium membership fees within thirty-one month (31) days of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; •  if you cease to be an eligible person; •  if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; •  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, your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; •  if fraud is determined 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 under your group coverage, or any other coverage that may become available in the future. You will NOT be offered membership in our direct pay plan; or •  if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: •  abusive or disruptive behavior in a physician’s office; •  repeated refusals by a member to accept procedures or treatment recommended by a physician; and •  impairing the ability of the 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 you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, agreement terminates for one of the reasons listed above, terminate this agreement, we must send to you above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why the this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium membership fees within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 coverage, so you can receive credit for it. This information may help you obtain a special enrollment under a new plan. We will also send to you 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 endend automatically: • if you leave your place of workon the date the premium is not paid (see Section 1.13 - Premium and Grace Period); • if you decide to discontinue coverage, we, your employer/agent, or HealthSource RI must receive notice to end this agreement fourteen (14) days 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 premium; • if you or your employer/agent does not pay any required premium within one month first day of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if 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; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end; • if date fraud is determined by usidentified. 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 due to the fraud. BCBSRI may decline reinstatement under of your group coverage, or . We may decline enrollment in any other coverage coverages we offer that may become available in the future, as well; or • if the date abuse or disregard for provider protocols and policies is determined identified by us. If after making a reasonable effort physicians are the provider is unable to establish or maintain keep a satisfactory relationship with a member, coverage may be terminated end after thirty-one (31-) days’ written notice. Examples of unsatisfactory physician-provider and patient relationships include: • abusive or disruptive behavior in a physician’s provider‘s office; • repeated refusals by a member to accept procedures or treatment recommended by a physicianprovider; and • impairing the ability of the physician provider to provide care. If you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this 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. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 will also send to you 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, your employer/agent, or HealthSource RI . We must receive your notice to end this agreement fourteen (14) days 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 premiummembership fees; • if you or your employer/agent does not pay any required premium membership fees within thirty-one month (31) days of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; • if you cease to be an eligible person; • if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; • 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, your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; • if fraud is determined 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 under your group coverage, or any other coverage that may become available in the future. You will NOT be offered membership in our direct pay plan; or • if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: • abusive or disruptive behavior in a physician’s office; • repeated refusals by a member to accept procedures or treatment recommended by a physician; and • impairing the ability of the 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 you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, agreement terminates for one of the reasons listed above, terminate this agreement, we must send to you above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why the this agreement ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium membership fees within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 coverage, so you can receive credit for it. This information may help you reduce a pre- existing condition exclusion period, obtain a special enrollment under a new plan, or get certain types of individual health coverage even if you have a health condition. We will also send to you 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, your employer/agent, or HealthSource RI . We must receive your notice to end this agreement fourteen (14) days 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 premiummembership fees; •  if you or your employer/agent does not pay any required premium membership fees within thirty-one month (31) days of the date they are due. If your employer/agent does not pay the required fees, the termination will be effective five (5) days after we mail you a notice of discontinuance; •  if you cease to be an eligible person; •  if we cease to offer this type of coverage; • for a covered dependent if the dependent no longer qualifies as an eligible dependent; •  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, your group’s agreement with us will end. You will NOT be offered membership in our direct pay plan; •  if fraud is determined 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 under your group coverage, or any other coverage that may become available in the future. You will NOT be offered membership in our direct pay plan; or •  if abuse or disregard for provider protocols and policies is determined by us. If after making a reasonable effort physicians are unable to establish or maintain a satisfactory relationship with a member, coverage may be terminated after 31-days’ written notice. Examples of unsatisfactory physician-patient relationships include: •  abusive or disruptive behavior in a physician’s office; •  repeated refusals by a member to accept procedures or treatment recommended by a physician; and •  impairing the ability of the 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 you purchase coverage from HealthSource RI and the Qualified Health Plan is terminated or decertified, coverage under this If we, agreement terminates for one of the reasons listed above, terminate this agreement, we must send to you above a termination notice will be sent to you thirty (30) days before the termination date. The notice will indicate the reason why the agreement this plan ended. When your coverage ends, you will be entitled to apply for direct pay membership from BCBSRI Blue Cross & Blue Shield of Rhode Island or through HealthSource RI. You must meet the eligibility requirements. We must receive an application and premium membership fees within sixty (60) days from the date your group membership ends. If you do not reside in Rhode Island, you do not qualify to enroll in our direct pay plans. You may be able to obtain coverage through an insurance company in the state in which you reside. 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 coverage, so you can receive credit for it. This information may help you obtain a special enrollment under a new plan. We will also send to you a HIPAA certificate of creditable coverage upon request.