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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 upon 45 days written notice in the following events:
- the Program is terminated by Delta Dental at the end of the annual Contract Term because of our decision not to renew the Contract;
- your behavior is disruptive, unruly, abusive, unlawful, fraudulent, or uncooperative to the extent that your continuing participation seriously impairs the organization's ability to provide services to other enrollees;
- you commit fraud or misrepresentation in applying for or presenting any claim for Benefits under the Contract;
- you misuse the documents provided as evidence of Benefits available under the Contract; or
- you furnish 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 your behavior is not due to the use of the services or mental illness.
Your coverage 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). Any cancellation is subject to the notification requirements set forth in this booklet. |
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