ELIGIBILITY FOR COVERAGE Any employee and the dependents of an employee who meet and continue to meet the eligibility requirements described in this Contract, will be entitled to apply for coverage under this Contract. These eligibility requirements are binding upon you and your eligible dependents. We may require acceptable documentation that an individual meets and continues to meet the eligibility requirements (e.g. proof of residency, copies of a court order naming the Subscriber as legal guardian, or appropriate adoption documentation, as described in Part IV. ENROLLMENT AND EFFECTIVE DATE OF COVERAGE).
When Your Coverage Begins Your coverage will begin on the first day of the month following your eligibility date as long as we receive required enrollment information within the first thirty (30) days following your eligibility date and the premium is paid. If you or your dependents fail to enroll at this time, you cannot enroll in the plan unless you do so through an Open Enrollment Period or a Special Enrollment Period.
Requiring Minimum Compensation for Covered Employees a. Contractor agrees to comply fully with and be bound by all of the provisions of the Minimum Compensation Ordinance (MCO), as set forth in San Francisco Administrative Code Chapter 12P (Chapter 12P), including the remedies provided, and implementing guidelines and rules. The provisions of Sections 12P.5 and 12P.5.1 of Chapter 12P are incorporated herein by reference and made a part of this Agreement as though fully set forth. The text of the MCO is available on the web at xxx.xxxxx.xxx/xxxx/xxx. A partial listing of some of Contractor's obligations under the MCO is set forth in this Section. Contractor is required to comply with all the provisions of the MCO, irrespective of the listing of obligations in this Section.
Child Coverage Limited to Coverage Under One Employee If both spouses work for the State or another organization participating in the State’s Group Insurance Program, either spouse, but not both, may cover the eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried employees who share legal responsibility for their eligible dependent children or grandchildren.
When Your Coverage Ends Coverage under this plan is guaranteed renewable. It can only be canceled by us for the following reasons: • if you leave your place of employment; • if you decide to discontinue coverage. Inform your employer prior to the requested date of cancellation and your employer will notify us. 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 premium; • if the required premium is not paid within one month of the due date. We will mail you a notice of discontinuance along with information about enrolling in an individual healthcare plan; • if you or a covered dependent no longer qualifies as an eligible person; • if we no longer offer this type of coverage; • if your employer contracts with another insurer or entity to provide or administer benefits for the covered healthcare services provided by this agreement; • if fraud is determined by us. See Rescission of Coverage section below for additional details; If your healthcare coverage is terminated for one of the reasons listed above, we will send you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why your healthcare coverage has ended. When your coverage ends, you may apply for individual healthcare coverage directly from BCBSRI or through HSRI. You must meet the eligibility requirements and we must receive required enrollment information within sixty (60) days from the date your group coverage ended along with required premium. If you do not reside in Rhode Island, you are not eligible to enroll in an individual plan from BCBSRI or HSRI. You may be able to obtain coverage through an insurance company in the state in which you reside. Rescission of Coverage Rescission is 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 • is due to non-payment of premiums, which can have a retroactive cancellation effect. 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 a 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 at least thirty (30) days in advance. Except for non-payment, we will not contest this policy after it has been in force for a period of two (2) years from the later of the effective date of this agreement or the latest reinstatement date.
Domestic Partner Coverage This Contract covers domestic partners of Subscribers as Spouses. If You selected family coverage, Children covered under this Contract also includes the Children of Your domestic partner. Proof of the domestic partnership and financial interdependence must be submitted in the form of:
Waiting Periods for Coverage There is a two (2) day Waiting Period per Pet before We will cover an Injury. There is a three hundred and sixty-five (365) day Waiting Period per Pet before We will cover a Pre-existing Condition. Waiting Periods are waived for subsequent renewals and add-on coverage from a preceding Policy year provided You maintain an active Policy, with no gap in coverage, annually renewed and continuously in-force.
When You Are Covered by More Than One Insurer A healthcare coverage plan is considered the primary plan and its benefits will be paid first if: • the plan does not use similar COB rules to determine coverage; or • the plan does not have a COB provision; or • The plan has similar the COB rules and is determined to be primary under the order of benefit determination rules described below. Benefits under another plan include all benefits that would be paid if claims had been initially submitted under that plan. The following factors are used to determine which plan is primary and which plan is secondary: • if you are the main subscriber or a dependent; • if you are married, which spouse was born earlier in the year; • the length of time each spouse has been covered under the plan; • if a parental custody or divorce decree applies; or • if Medicare is your other coverage then Medicare guidelines will apply. These factors make up the order of benefit determination rules, described in greater detail below:
’ Compensation and Employer’s Liability Coverage The Grantee shall provide workers’ compensation, in accordance with Chapter 440, F.S. and employer liability coverage with minimum limits of $100,000 per accident, $100,000 per person, and $500,000 policy aggregate. Such policies shall cover all employees engaged in any work under the Grant.
Requiring Health Benefits for Covered Employees Contractor agrees to comply fully with and be bound by all of the provisions of the Health Care Accountability Ordinance (HCAO), as set forth in San Francisco Administrative Code Chapter 12Q, including the remedies provided, and implementing regulations, as the same may be amended from time to time. The provisions of section 12Q.5.1 of Chapter 12Q are incorporated by reference and made a part of this Agreement as though fully set forth herein. The text of the HCAO is available on the web at xxx.xxxxx.xxx/xxxx. Capitalized terms used in this Section and not defined in this Agreement shall have the meanings assigned to such terms in Chapter 12Q.
