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| RENEWAL, CANCELLATION AND TERMINATION OF BENEFITS |
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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 60 days before your coverage expires. Your desire to renew the Contract is indicated by payment of the renewal Premium prior to the end of the Contract Term. If you do not send the renewal Premium by this time, we will assume that you do not wish to continue coverage. In this case, Benefits will terminate at the end of the Contract Term.
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.
Subject to the Extension of Benefits provision below, Delta Dental will cancel enrollment in the following events:
Immediately;
- For any Eligible Dependent, 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 disability 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 25;
Upon 45 days written notice if
- the Program is terminated by Delta Dental at the end of the annual Contract Term because of our decision not to renew the Contract;
- the Enrollee's behavior is disruptive, unruly, abusive, unlawful, fraudulent, or uncooperative to the extent that their continuing participation seriously impairs the organization's ability to provide services to other enrollees;
- the Enrollee commits fraud or misrepresentation in applying for or presenting any claim for Benefits under the Contract;
- the Enrollee misuses the documents provided as evidence of Benefits available under the Contract; or
- the Enrollee furnishes incorrect or incomplete information to Delta Dental in order to fraudulently obtain services.
Prior to cancellation, Delta Dental will make every effort to resolve problems through the grievance procedures and will determine that the Enrollee's behavior is not due to the use of the services or mental illness.
Coverage for an Enrollee will terminate as of the date enrollment is cancelled under the terms of this Contract. However, we will continue to provide Benefits for completion of any treatment in progress (less any applicable Copayment). Cancellation of a primary Enrollee's enrollment, as described above, shall automatically cancel the enrollment of any of his or her dependent Enrollees. Any cancellation is subject to the notification requirements set forth in this booklet. |
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