|
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 45 days before your coverage expires. Your coverage will terminate at the end of the Grace Period unless you renew by paying the applicable Premium on or before the end of the Grace Period. Refer to Grace Period for additional information regarding the Grace Period.
We will cancel enrollment of an Eligible Dependent immediately upon receipt of a written notice regarding the loss of dependent status. However, an unmarried dependent child may continue coverage if:
- he or she is incapable of self-support because of a mental or physical 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 is provided within 31 days of request by ALPHA and subsequently as required. Such requests will not be made more than once a calendar year after the Eligible Dependent reaches age 21. Eligibility will continue as long as the dependent relies on you for support because of a physical or mental incapacity that began before he or she reached the limiting age. The dependent child is not required to reside with a parent or legal guardian who is an Enrollee.
Coverage for Eligible Dependents beyond the limiting age will continue in effect until the end of the period for which we have accepted premium. ALPHA’s liability is limited to a refund, on request, of the premiums paid for the period not covered by the contract if the age of the Eligible Dependent is misstated and according to the correct age of the covered dependent, the coverage provided by the Contract would not have become effective.
We will also cancel coverage upon 30 days written notice if any of the following occur:
- the Enrollee knowingly commits or permit another person to commit fraud or deception in obtaining Benefits under this Program;
- the Enrollee engages in conduct detrimental to safe operations and the delivery of services while in a Contract Dentist’s facility;
- The Enrollee fails to pay Copayments; provided, however, that you may be reinstated during the term of this Program upon payment of all delinquent charges.
Should the death of an Enrollee occur during a period for which premium has been paid, we will refund the portion of the premium that applies to the period beyond the end of the month in which the death occurred.
Coverage for an Enrollee will terminate as of the date enrollment is cancelled under the terms of this Contract. Cancellation of a Primary Enrollee’s enrollment, as described above, shall automatically cancel the enrollment of any of his or her Dependent Enrollees. ALPHA will not be obligated to continue to provide Benefits to any Enrollee in such event, except for the following situations:
ALPHA will continue to provide Benefits for treatment in progress (less any applicable Copayment) if the treatment:
- began before the date coverage terminates, and
- requires two or more visits on separate days to the assigned Contract Dentist’s facility.
Benefits will cease 90 days after termination of coverage.
If you are receiving orthodontic treatment at the time of termination, ALPHA will continue to provide orthodontic Benefits for:
- 60 days if you are making monthly payments to the Contract Orthodontist, or
- until the later of 60 days or the end of the quarter in progress, if you are making quarterly payments to the Contract Orthodontist.
If a Contract Dentist is aware that the Contract between an Applicant and ALPHA has terminated, the Contract Dentist shall inform any previously enrolled person who visits his/her facility of the termination and of all charges for scheduled dental services before treatment is begun. |
