Reso 2010-1529 - Laserfiche WebLink

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d) There is no longer any enrollee in connection with the Plan who lives, resides, or works in the Service Area. Termination of coverage will be effective on the last day of the month for which payments were received by AvMed. e) AvMed ceases to offer coverage in the applicable market. AvMed will provide written notice to Subscribing Group at least 180 days prior to such termination. Termination of Coverage for Cause. AvMed may terminate any Member immediately upon written notice for the following reasons which lead to a loss of eligibility of the Member: a) Fraud, material misrepresentation, or omission in applying for membership, benefits, or coverage under this Contract. However, relative to a misstatement in the Application, after two years from the issue date, only fraudulent misstatements in the Application may be used to void the policy or deny any claim for a loss occurred or disability starting after the two year period; b) Misuse of AvMed's identification card furnished to the Member; c) Furnishing to AvMed incorrect or incomplete information for the purpose of obtaining membership, coverage, or benefits under this Contract; or d) Behavior which is disruptive, unruly, abusive, or uncooperative to the extent that the Member1s continuing coverage under this Contract seriously impairs AvMed's ability to administer this Contract or to arrange for the delivery of health care services to the Member or other Members after AvMed has attempted to resolve the Member's problem. e) At the effective date of such termination, premium payments received by AvMed on account of such tennination shall be refunded on a pro rata basis, and AvMed shall have no further liability or responsibility for the Member under this Contract. Notification Requirements: Loss of eligibility of Subscriber. it is the responsibility of Subscribing Group to notify AvMed in writing within 31 days from the effective date of tennination regarding any Subscriber and/or Dependent who becomes ineligible to participate in the Plan. Failure of the Subscribing Gronp to provide timely written notice as described above may lead to retroactive tenllination of the Subscriber and/or Dependent. The effective date for slich retroactive termination will be the last day of the month for which the premium was paid and during which the Subscriber and/or Dependent was eligible for coverage. See Section 6.06. Loss of cligibility of Dependent. When a Dependent becomes ineligible for Dependent coverage, the Subscriber is required to notify AvMed in writing within 31 days of the Dependent becoming ineligible. Contract Termination. In the event this Contract is terminated, the Subscribing Group agrees that it shall provide 45 days prior written notification of the date of such termination to its employees who are Subscribers covered under this Contract. In no event will any retroactive termination of a Member be made beyond 60 days from notification of the terminating event. 8.03 Certificates of Coverage. If your coverage under the Plan ends, you will automatically receive a Certificate of Group Health Plan Coverage. You may take this certificate to another health care plan to receive credit for your coverage under the Plan. You will only need to do this if the other health care plan has a pre-existing condition limit. You can request a Certificate of Group Health Plan Coverage anytime during the 24-month period after the date your coverage under the Plan has ended. 8.01.05 8.02 8.02.01 8.02.02 8.02.03 8.02.04 A V-CHOlCE-2009 MP-5320 (10/09) ) ) , ) ) 17