Reso 2010-1529 - Laserfiche WebLink

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") ) In the event of the retroactive tennination of an individual Member (as described in Subsections 8.01.02 and 8.02.01 of this Contract), AvMed shal1 not be responsible for medical expenses incurred by AvMed in providing benefits to the Member under the terms of this Contract after the effective date of termination (due to the Subscribing Group's nonpayment of premiums or failure to timely notify AvMed of Member ineligibility). At the discretion of AvMed, and based on the facts available to AvMed at the time, AvMed may pursue either the Subscribing Group or the Member for payment. 6.06 VII. CONVERSION A Subscriber or covered Dependent whose coverage under the Subscribing Group Contract has been terminated for any reason, including discontinuance of the Subscribing Group Contract in its entirety or with respect to a covered class, and who has been continuously covered under the Subscribing Group Contract, and under any group health maintenance contract providing similar benefits which it replaces, for at least three months immediately prior to termination, shall be entitled, subject to the exceptions contained herein, to have issued to him or her a Conversion Contract (See Section 2.14), unless there is a replacement of discontinued group coverage by similar group coverage within 31 days. 7.01 o 7.01.01 7.01.02 ) 7.01.03 7.01.04 7.01.05 AV-CHOICE-2009 MP.5320 (10/09) The converting Subscriber and each of the eligible Dependents of the Subscriber who are converting must be Members of the Plan in good standing on the date when their coverage terminates under this Group Contract, and all such Subscribers and Dependents, after complying with Subsection 7.01.02 below, shall be covered under the Individual Conversion Contract. A completed Status Change form requesting conversion shall be sent to AvMed or its designated administrator with the first applicable premium and shall be received by AvMed or its designated administrator not later than 63 days after the date of termination of this Group Contract. Dependents may not convert without the Subscriber except: a) In the event of the death of the Subscriber, Dependents are permitted an automatic conversion privilege and must comply with Subsection 7.01.02 above; or b) A spouse whose coverage would terminate, or a spouse and children whose coverage would otherwise terminate at the same time, or a child with respect to himself, by reason of ceasing to be a qualified family member, may convert and must comply with Subsection 7.01.02 above; or c) A former spouse whose coverage would otherwise terminate because of annulment or dissolution of marriage may convert if the former spouse is dependent for financial support. The former spouse must comply with Subsection 7.01.02 above and must provide written evidence of financial dependence upon request of AvMed. Payment for health care services rendered to a Member after termination and prior to conversion shall be the responsibility of the Member. When the conversion application has been timely completed (within 63 days after termination of the Group Contract) and the first premium duc has been paid, AvMed shall reimburse the Subscriber for any payment made by the Subscriber for covered Medical Services under the converted Contract. A new Conversion Contract is established upon application and payment of the premium on the day following the Member's termination from group coverage (due to ineligibility under the Group Contract) and continues through the end of the calendar year. The Contract Year, upon renewal, shall be the calendar year. 14