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RENEWAL, CANCELLATION AND TERMINATION OF BENEFITS
No change in Benefits or Premium will be made during a Contract Term. We will send you a written renewal notice, including any proposed changes in Benefits and/or Premium at least 30 days before your coverage expires. Your coverage will terminate at the end of the Contract Term unless you renew by paying the applicable Premium on or before the expiration date of your Contract.
Receipt of the applicable Premium by us after termination of your coverage will reinstate your coverage unless payment is received more than 15 days after termination and we refund such payment within 20 business days. You may request reinstatement of coverage for up to one year following the expiration of your Contract Term. However, reinstated coverage will always be retroactive to the date immediately following the end of the previous Contract Term. If a later date is requested, which would result in a gap in coverage, you must complete new enrollment forms and pay the enrollment fee as well as the annual premium.
Enrollment will be cancelled by Delta Dental in the following events:
- For any Eligible Dependent, immediately upon receipt of a written notice regarding the loss of dependent status; however, an unmarried dependent child may continue eligibility if:
- he or she is incapable of self-support because of a physical or mental incapacity that began prior to reaching the limiting age,
- he or she is chiefly dependent on you for support, and
- proof of dependent's disability or incapacity is provided within 31 days of request by Delta Dental and subsequently as required. Such requests will not be made more than once a year after the Eligible Dependent reaches age 21;
- Immediately, if Delta Dental determines that the Enrollee is guilty of misconduct detrimental to safe operations and the delivery of services while in a Contract Dentist's facility;
- Upon 15 days written notice if the Enrollee knowingly perpetrates or permits another person to perpetrate fraud or deception in obtaining Benefits under this Program;
- Upon 30 days written notice if the Enrollee fails to pay Copayments; provided, however, that the Enrollee may be reinstated during the term of this Program upon payment of all delinquent charges;
- Upon 30 days written notice upon failure of an Enrollee and a Contract Dentist to establish a satisfactory patient-dentist relationship if it is shown that Delta Dental has, in good faith, provided the Enrollee with the opportunity to select an alternative Contract Dentist, and the Enrollee has been notified in writing at least 30 days in advance that Delta Dental considers the patient-dentist relationship to be unsatisfactory and specifies the changes that are necessary in order to avoid cancellation, and the Enrollee has failed to make such changes.
If we cancel your coverage for any other reason or if you cancel coverage by giving us 30 days' advance written notice because
- no Contract Dentist is available to you,
- you move out of the DeltaCare USA service area, or
- you change to coverage under a group program,
Delta Dental will, within 30 days, return to you the pro rata portion of the Premium paid for any unexpired period for which payment has been received, together with amounts due on claims, if any, less any amounts due to us. Otherwise, no refunds will be made.
Coverage for an Enrollee will terminate as of the date enrollment is cancelled under the terms of this Disclosure Form/Contract. However, we will continue to provide Benefits for completion of any treatment in progress (less any applicable Copayment). Cancellation of enrollment of a primary Enrollee will automatically cancel the enrollment of a dependent Enrollee. Any cancellation is subject to the written notification requirements set forth in this booklet.
An Enrollee who believes that enrollment has been cancelled or not renewed because of dental condition or the need for dental care may request a review of the cancellation by the Director of the Department of Managed Health Care of the State of California. |
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