Reso 2010-1529 - Laserfiche WebLink

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I') ) q ) Tennination resulting from failure to pay premiums on a timely basis or termination of coverage for cause (due to fraud, intentional misrepresentation, etc.) will not provide a special el110llment period. 4.04 The eligibility requirements set forth in Part III shall at all times control and no coverage contrary thereto shall be effective. Coverage shall not be implied due to clerical or administrative errors if such coverage would be contrary to Part Ill. (Also see Section 16.05). 4.03.03 4.05 This Contract, at the sole option of AvMed, will not be accepted if at the time of initial offering to Subscribing Group or, following re-enrollment, the total enrollment does not result in a predetermined minimum el110llment as established by AvMed. The required minimum group enrollment is inclnded in the rate letter submitted to Subscribing Group. V. EFFECTIVE DATE OF MEMBERSHIP Snbject to the payment of applicable monthly premium charges set forth in Part VI and to the provisions of this Contract, coverage under this Plan shall become effective on the following dates: 5.01 Eligible employees, Subscribers and Dependents who enroll during the open enrollment period will be covered Members as of the effective date of this Contract or subsequent anniversary thereof. 5.02 If a Subscriber acquires an eligiblc Dependent through birth, adoption, placement for adoption or marriage, such Dependent shall be treated as covered under the Plan if, within 31 days (or as otherwise provided for newborns in Part III) of acquiring the new Dependent, the Subscriber completes and submits an el110llment form on behalf of such Dependent. If received by AvMed within the 31 day time period (or 60 days as permitted for newboms), the enrollment for such Dependent shall become effective on the date of the birth, adoption or placement for adoption, or in the case of marriage, on the first day of the month following the date of marriage. During this period, the Subscriber and the Subscriber's eligible spouse may also enroll for medical coverage under the Plan if not already covered. However, if an enrollment request is not received by AvMed within the required time frame, the Subscriber and the Subscriber's eligible Dependents will be required to wait until the next open enrollment period to apply for coverage. 5.03 Coverage for the newborn child of the Subscriber or the newbom child of the Subscriber's covered Dependent is effective at birth if Subsection 3.02.02(i) and Section 5.02 are complied with. 5.04 If the Subscriber or the Subscriber's Dependents originally declined medical coverage under the Plan due to other health coverage, and that coverage is subsequently terminated as a result of either a loss of eligibility for such coverage or the tennination of any employer contributions for such coverage, the Subscriber and the Subscriber's Dependents will be eligible to enroll in the Plan. To enroll, you must complete and submit an Enrollment form within 31 days of the loss of such other coverage or the termination of employer contributions. The effective date of any coverage provided by AvMed will be the first day of the month following the date you enroll. If the Subscriber fails to el110ll within 31 days after the loss of other coverage, the Subscriber and the Subscriber's eligible Dependents must wait until the next open el110llment period to apply for coverage. 5.05 If the Subscriber or the Subscriber's Dependents are eligible for coverage but not enrolled, and experience a tennination of coverage under Medicaid or CHIP due to loss of eligibility, or are determined to be eligible for premium assistance under Medicaid or CHIP, the Subscriber and the Subscriber's Dependents will be eligible to enroll in the Plan. To enroll, the Subscriber must complete and submit an enrollment form within 60 days of the loss of such coverage or the determination of such eligibility. The effective date of any coverage provided by AvMed will be the first day of the month 12 A V-CHOlCE-2009 MP-5320 (10/09)