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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 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.
We will cancel enrollment 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 ALPHA and subsequently as required. Such requests will not be made more than once a year after the Eligible Dependent reaches age 25;
- Immediately, if 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;
- Upon 30 days written notice if the Enrollee or dependent Enrollee neither resides, lives or works in ALPHA's Service Area. However, coverage for a child who is the subject of a medical support order cannot be cancelled solely because the child does not reside, live or work in ALPHA's Service Area;
- 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. ALPHA must show that it has, in good faith, provided the Enrollee with the opportunity to select an alternative Contract Dentist. In addition, ALPHA must provide 30 days advance, written notice that ALPHA considers the patient-dentist relationship to be unsatisfactory and must specify the changes that are necessary in order to avoid cancellation. Coverage will be cancelled if the Enrollee fails to make such changes;
- Upon 90 days written notice if ALPHA discontinues coverage of this Individual/Family Dental HMO Program uniformly without regard to health status related factors of Enrollees.
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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