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 unless you renew by paying the applicable Premium on or before the end of the grace period. Refer to the My Costs section for additional information regarding the Grace Period.
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.
ALPHA will cancel enrollment in the following events:
Immediately
- for any Eligible Dependent, upon 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 ALPHA and subsequently as required. Such
requests will not be made more than once a year after the Eligible Dependent reaches age 26; or
- if an Enrollee engages in conduct 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 commits or permits another person to commit fraud or deception in obtaining Benefits under the Contract;
Upon 30 days written notice if
- the Contract is terminated at the end of the annual Contract Term because of our decision not to renew the Contract; or
- the Premiums are not paid by or on behalf of the Enrollee on the date due, or within the 30 day Premium grace period. However the Enrollee may continue to receive Benefits during the 30-day period and may be reinstated during the term of this Contract upon payment of any unpaid Premium; or
- the Enrollee fails to pay Copayments. However, the Enrollee may be reinstated during the term of the Contract upon payment of all delinquent charges; or
- a satisfactory dentist-patient relationship fails to be established with multiple contract facilities. ALPHA must show that it has, in good faith, provided the Enrollee with the opportunity to select an alternative Contract Dentist. If the Enrollee establishes a history of unsatisfactory relationships, ALPHA will notify the Enrollee in writing, at least 30 days in advance, that they consider the dentist-patient relationship to be unsatisfactory.ALPHA will also specify the changes that are necessary in order to avoid cancellation,
and show that the Enrollee failed to make these changes.
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. |
