Common use of Eligibility and Enrollment Clause in Contracts

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this plan. Subscribers must reside in a Blue Shield service area for this plan within California to be eligible to enroll in coverage. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence of Coverage and Health Service Agreement. See the Definition of Dependent for additional information. If a Member commits any of the following acts, he or she will immediately lose eligibility to continue enrollment:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this planestablished by Covered California. Subscribers must reside in a Blue Shield service area for this plan within California to be eligible to enroll in coveragecoverage through Covered California. A permanent relocation within California may make a Subscriber and/or Dependent eligible for a Special Enrollment Period. To learn about all eligibility requirements for this health plan, please contact Covered California. Eligibility determinations made by Covered California can be appealed. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield Covered California will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Covered California or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield Covered California within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield Covered California to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence of Coverage and Health Service Agreement. See the Definition of Dependent for additional information. If a Member commits any of the following acts, he or she will immediately lose eligibility to continue enrollment:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this plan. Subscribers must reside in a Blue Shield service area for this plan within California to be eligible to enroll in coverage. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence of Coverage and Health Service Agreement. See the Definition of Dependent for additional information. If a Member commits any Effective Date of Coverage Blue Shield will notify the Subscriber of the following actsEffective Date of coverage for the Subscriber and his or her Dependents. Coverage starts at 12:01 a.m. Pacific Time on the Effective Date. Other than during the annual Open Enrollment Period, a Subscriber or Dependent may not enroll in health coverage in the individual market unless the Subscriber or Defendant qualifies for a Special Enrollment Period. If an individual qualifies for a Special Enrollment Period, he or she must apply within the time limits applicable to the event that qualified the applicant for a Special Enrollment Period. If a Subscriber enrolls mid-year during a Special Enrollment Period, his or her plan benefit year will immediately lose eligibility end December 31. Effective dates will vary based on the circumstances of the Special Enrollment Period according to continue enrollmentthe guidelines established by federal and state law. In general, if a Service to discuss these options or visit xxx.xxxxxxxxxxxx.xxx. Payments by mail are to be sent to: Blue Shield of California P.O. Box 6051451827 City of Industry, CA 91716-0514 Additional Premiums may be charged in the event that a state or any other taxing authority imposes upon Blue Shield a tax or license fee which is calculated upon base Premiums or Blue Shield of California's gross receipts or any portion of either. Premiums may also increase from time to time as determined by Blue Shield in accordance with federal and state law and regulations. Relocating to a different geographic rating area may lead to a change in Premium based on rating differences between geographic areas. Blue Shield will provide 60 days written notice of any changes in the monthly Premiums for this plan. Subscriber or Dependent qualifies for a Special Enrollment Period (see Definitions), and the Subscriber submits a premium payment that is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first of the month after receipt of payment. If the Subscriber submits a premium payment that is delivered or postmarked after the 15th of the month, coverage will be effective on the first of the second month after receipt of payment. However, if the Subscriber qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage, or Domestic Partnership, and enrollment is requested within 60 days of the event, the Subscriber may request enrollment for those Dependents within 60 days. The effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this planestablished by Covered California. Subscribers must live or reside in a Blue Shield service area for this plan within California to be eligible to enroll in coveragecoverage through Covered California. A permanent relocation within California may make a Subscriber and/or Dependent eligible for a Special Enrollment Period. To learn about all eligibility requirements for this health plan, please contact Covered California. Eligibility determinations made by Covered California can be appealed. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield Covered California will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Covered California or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield Covered California within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield Covered California to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence of Coverage and Health Service Agreement. See the Definition of Dependent for additional information. If a Member commits any Effective Date of Coverage Blue Shield will notify the Subscriber of the following actsEffective Date of coverage for the Subscriber and his or her Dependents. Coverage starts at 12:01 a.m. Pacific Time on the Effective Date. Other than the annual Open Enrollment Period, a Subscriber or Dependent may not enroll in health coverage in the individual market unless the Subscriber or Defendant qualifies for a Special Enrollment Period. If an individual qualifies for a Special Enrollment Period, he or she must apply within the time limits applicable to the event that qualified the applicant for a Special Enrollment Period. If a Subscriber enrolls mid-year during a Special Enrollment Period, his or her plan benefit year will immediately lose eligibility end December 31. Effective dates will vary based on the circumstances of the Special Enrollment Period according to continue enrollmentthe guidelines established by federal and state law. In general, if a Subscriber or Dependent qualifies for a Special Enrollment Period (see Definitions), and the Subscriber submits a premium payment that is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first of the month after receipt of payment. If the Subscriber submits a premium payment that is delivered or postmarked after the 15th of the month, coverage will be effective on the first of the second month after receipt of payment. However, if the Subscriber qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage, or Domestic Partnership, and enrollment is requested within 60 days of the event, the Subscriber may request enrollment for those Dependents within 60 days. The effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this plan. Subscribers must reside in a Blue Shield service area for this plan within California to be eligible to enroll in coverage. Eligibility for catastrophic plans is limited to: (1) individuals who have not attained the age of thirty (30) before the beginning of the plan year; and (2) individuals who have obtained certification in effect for the plan year from Covered California certifying that they are exempt from the requirement to maintain minimum essential coverage under Internal Revenue Code Section 5000A due to either a lack of affordable coverage or a demonstrated hardship. Each individual enrolled in a single catastrophic plan must meet at least one of the eligibility criteria. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence of Coverage and Health Service Agreement. See the Definition of Dependent for additional information. If a Member commits any of the following acts, he or she will immediately lose eligibility to continue enrollment:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this planestablished by Covered California. Subscribers must reside in a Blue Shield service area for this plan within California to be eligible to enroll in coveragecoverage through Covered California. A permanent relocation within California may make a Subscriber and/or Dependent eligible for a Special Enrollment Period. To learn about all eligibility requirements for this health plan, please contact Covered California. Eligibility determinations made by Covered California can be appealed. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield Covered California will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Covered California or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield Covered California within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield Covered California to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence Effective Date of Coverage Blue Shield will notify the Subscriber of the Effective Date of coverage for the Subscriber and Health Service Agreementhis or her Dependents. See Coverage starts at 12:01 a.m. Pacific Time on the Definition of Effective Date. Other than during the annual Open Enrollment Period, a Subscriber or Dependent may not enroll in health coverage in the individual market unless the Subscriber or Defendant qualifies for additional informationa Special Enrollment Period. If an individual qualifies for a Member commits any of the following actsSpecial Enrollment Period, he or she must apply within the time limits applicable to the event that qualified the applicant for a Special Enrollment Period. If a Subscriber enrolls mid-year during a Special Enrollment Period, his or her plan benefit year will immediately lose eligibility end December 31. Effective dates will vary based on the circumstances of the Special Enrollment Period according to continue enrollmentthe guidelines established by federal and state law. In general, if a Subscriber or Dependent qualifies for a Special Enrollment Period (see Definitions), and the Subscriber submits a premium payment that is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first of the month after receipt of payment. If the Subscriber submits a premium payment that is delivered or postmarked after the 15th of the month, coverage will be effective on the first of the second month after receipt of payment. However, if the Subscriber qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage, or Domestic Partnership, and enrollment is requested within 60 days of the event, the Subscriber may request enrollment for those Dependents within 60 days. The effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must meet all of the eligibility requirements of this plan. Subscribers must live or reside in a Blue Shield service area for this plan within California to be eligible to enroll in coverage. A Subscriber or Dependent may enroll during the annual Open Enrollment Period. Under certain circumstances, an individual or Dependent may qualify for a Special Enrollment Period. Other than during the annual Open Enrollment Period, or a Special Enrollment Period, a Subscriber or Dependent may not enroll in this heath plan. Blue Shield will provide the Subscriber with a notice of the annual Open Enrollment Period each year. For additional information on enrollment periods, please contact Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an application must be received by Blue Shield within 60 days from the date of birth, adoption or placement for adoption. Please contact Blue Shield to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their coverage under this health plan solely because of age, may continue to be eligible for coverage if they continue to meet the definition of Dependent in this Evidence of Coverage and Health Service Agreement. See the Definition of Dependent for additional information. If a Member commits any Effective Date of Coverage Blue Shield will notify the Subscriber of the following actsEffective Date of coverage for the Subscriber and his or her Dependents. Coverage starts at 12:01 a.m. Pacific Time on the Effective Date. Other than the annual Open Enrollment Period, a Subscriber or Dependent may not enroll in health coverage in the individual market unless the Subscriber or Defendant qualifies for a Special Enrollment Period. If an individual qualifies for a Special Enrollment Period, he or she must apply within the time limits applicable to the event that qualified the applicant for a Special Enrollment Period. If a Subscriber enrolls mid-year during a Special Enrollment Period, his or her plan benefit year will immediately lose eligibility end December 31. Effective dates will vary based on the circumstances of the Special Enrollment Period according to continue enrollmentthe guidelines established by federal and state law. In general, if a Subscriber or Dependent qualifies for a Special Enrollment Period (see Definitions), and the Subscriber submits a premium payment that is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first of the month after receipt of payment. If the Subscriber submits a premium payment that is delivered or postmarked after the 15th of the month, coverage will be effective on the first of the second month after receipt of payment. However, if the Subscriber qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage, or Domestic Partnership, and enrollment is requested within 60 days of the event, the Subscriber may request enrollment for those Dependents within 60 days. The effective date of enrollment will be as follows: