Common use of Enrollment and Eligibility Clause in Contracts

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes based on BCBSRI’s enrollment guidelines and: • enroll only eligible persons without regard to health status factors; • notify BCBSRI of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. Retroactive enrollment changes will not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: • will be requested to correct administrative errors; • in the absence of such administrative error, will be requested to enroll or cancel Employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and • shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date of retroactive cancellations shall be the last day of the month and shall not be more than thirty (30) days before the day that the request for retroactive cancellation was received by BCBSRI. Retroactive cancellations will not be permitted by BCBSRI until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this the Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes based on BCBSRI’s enrollment guidelines and: • enroll only eligible persons without regard to health status factors; • notify BCBSRI of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. Retroactive enrollment changes will not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: • will be requested to correct administrative errors; • in the absence of such administrative error, will be requested to enroll or cancel Employees employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and • shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date of retroactive cancellations shall be the last day of the month and shall not be more than thirty (30) days before the day that the request for retroactive cancellation was received by BCBSRI. Retroactive cancellations will not be permitted by BCBSRI under these terms until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for when a claim has been incurred after the portion of the month covered up to the termination requested cancellation date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes changes, based on BCBSRI’s enrollment guidelines and: and • enroll only eligible persons without regard to health status factors; • notify BCBSRI of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. Retroactive enrollment changes will not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: • will be requested to correct administrative errors; • in the absence of such administrative error, will be requested to enroll or cancel Employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and • shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date of retroactive enrollment shall be the first of the month in which the request is received. The effective date of retroactive cancellations shall be the last day of the month and shall not be more than thirty sixty (3060) days before the day that the request for retroactive cancellation was received by BCBSRI. Retroactive cancellations will not be permitted by BCBSRI until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this the Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes based on BCBSRI’s enrollment guidelines and: • enroll only eligible persons without regard to health status factors; • notify BCBSRI of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. BCBSRI shall honor retroactive enrollment change requests from GROUP providing the request meet BCBSRI guidelines, as described in this section. Retroactive enrollment changes will beyond the stated timeframes listed below shall not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: • will be requested to correct administrative errors; • o in the absence of such administrative error, will be requested to enroll or cancel Employees employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and • shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date ; AND • GROUPS with 50 to 100 Subscribers, if request is received by BCBSRI: o on or before the fifteenth day of retroactive cancellations a calendar month shall be effective on the last first day of the preceding calendar month and shall not be more than thirty (30) days before the day that in which the request for retroactive cancellation was is received. o after the fifteenth day of a calendar month shall be effective on the first day of the calendar month in which the request is received. • GROUPS with 101 or more Subscribers, if request is received by BCBSRI: o on or before the fifteenth day of a calendar month shall be effective on the first day of the second calendar month proceeding the month in which the request is received. o after the fifteenth day of a calendar month shall be effective on the first day of the preceding calendar month in which the request is received. The number of Subscribers is based on the total number of Subscribers enrolled on the first day of the current Rating Period. Retroactive cancellations will not be permitted by BCBSRI under these terms until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes changes, based on BCBSRI’s enrollment guidelines and: and • enroll only eligible persons without regard to health status factors; • notify BCBSRI of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. Retroactive enrollment changes will not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: • will be requested to correct administrative errors; • in the absence of such administrative error, will be requested to enroll or cancel Employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and • shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date of retroactive enrollment shall be the first of the month in which the request is received.The effective date of retroactive cancellations shall be the last day of the month and shall not be more than thirty sixty (3060) days before the day that the request for retroactive cancellation was received by BCBSRI. Retroactive cancellations will not be permitted by BCBSRI until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.

Enrollment and Eligibility. Company agrees to enroll its Eligible Employees and to make changes in enrollment in accordance with BCBSRI eligibility and enrollment guidelines. Only an eligible person, as defined in employees and their dependents meeting the definition of eligible person under the applicable Subscriber Agreement, Agreement(s) shall be entitled to enroll eligible for Health Care Coverage under this Agreement. The effective date Company shall notify BCBSRI of enrollment the names of Eligible Members, who shall continue to be covered until BCBSRI is notified by Company that they are no longer eligible for an eligible person coverage. Any changes in eligibility, including additions or cancellations, must be given upon discovery to BCBSRI by telefax or electronically. Enrollment changes shall be effective on the first day of a calendar month. GROUP agrees to make Requested enrollment changes based on BCBSRI’s enrollment guidelines and: • enroll only eligible persons without regard to health status factors; • notify BCBSRI shall be effective no earlier than the first day of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. Retroactive enrollment changes will not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the calendar month in which the request is received. GROUP Retroactive enrollment changes not received within the preceding timeframes will not be honored by BCBSRI except as required by applicable law. Company agrees that retroactive enrollment changes: • changes will be requested only to correct administrative errors; • in the absence of such administrative error, will be requested to oversights and enroll or cancel Employees terminate employees and dependents on the date that they should have been enrolled or cancelled, based on terminated according to the terms of the applicable Subscriber Agreement(s); and • , in the absence of such administrative oversights. Without limiting the general applicability of the foregoing, such retroac- tive changes shall not request be used to enroll any person an employee or dependent who had previously declined to enroll when first eligible. The effective date of retroactive cancellations shall be the last day of the month and shall not be more than thirty (30) days before the day that the request for retroactive cancellation was received by BCBSRI. Retroactive Any retroac- tive cancellations will not be permitted considered and/or agreed to by BCBSRI under the preceding terms until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes , including any and all incurred claims not yet received and/or paid by BCBSRI, BCBSRI at the time of notification by GROUP Company of such requested retroactive cancellations. For Regarding any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP Company as a result of any retroactive adjustment(s), upon billing of GROUP Company by BCBSRI, GROUP Company agrees to reimburse all payments or allocations made by pay the monthly premium owed to BCBSRI on behalf of an Enrolled Member Eligible Employee or Eligible Dependent enrolled and then determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP Company further agrees that BCBSRI shall have no liability to GROUP Company for health care services rendered to such Enrolled Members incurred before the effective date Member on or after the termination dateconfirmed date of ineligibility.

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes based on BCBSRI’s enrollment guidelines and: • enroll only eligible persons without regard to health status factors; • notify BCBSRI of the name of eligible persons; and • notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. Retroactive enrollment changes will not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: • will be requested to correct administrative errors; • in the absence of such administrative error, will be requested to enroll or cancel Employees employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and • shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date of retroactive cancellations shall be the last day of the month and shall not be more than thirty (30) days before the day that the request for retroactive cancellation was received by BCBSRI. Retroactive cancellations will not be permitted by BCBSRI until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.

Enrollment and Eligibility. Only an eligible person, as defined in the Subscriber Agreement, shall be entitled to enroll for Health Care Coverage under this the Agreement. The effective date of enrollment for an eligible person shall be on the first day of a calendar month. GROUP agrees to make enrollment changes based on BCBSRI’s enrollment guidelines and: •  enroll only eligible persons without regard to health status factors; •  notify BCBSRI of the name of eligible persons; and •  notify BCBSRI of the names of persons no longer eligible for Health Care Coverage. Enrolled Members shall continue to be covered until GROUP notifies BCBSRI that such Enrolled Members are no longer eligible for Health Care Coverage. GROUP shall be responsible to pay BCBSRI for all Enrolled Members. GROUP agrees to send all changes, upon discovery, to BCBSRI via approved method of electronic enrollment notification or fax. BCBSRI shall honor retroactive enrollment change requests from GROUP providing the request meet BCBSRI guidelines, as described in this section. Retroactive enrollment changes will beyond the stated timeframes listed below shall not be honored, except as required by applicable law. The effective date of retroactive enrollment shall be the first of the month in which the request is received. GROUP agrees retroactive enrollment changes: •  will be requested to correct administrative errors; •  in the absence of such administrative error, will be requested to enroll or cancel Employees employees and dependents on the date that they should have been enrolled or cancelled, based on the terms of the applicable Subscriber Agreement(s); and •  shall not request to enroll any person who had previously declined to enroll when first eligible. The effective date ; AND  GROUPS with 50 to 100 Subscribers, if request is received by BCBSRI:  on or before the fifteenth day of retroactive cancellations a calendar month shall be effective on the last first day of the preceding calendar month and shall not be more than thirty (30) days before the day that in which the request for retroactive cancellation was is received.  after the fifteenth day of a calendar month shall be effective on the first day of the calendar month in which the request is received.  GROUPS with 101 or more Subscribers, if request is received by BCBSRI:  on or before the fifteenth day of a calendar month shall be effective on the first day of the second calendar month proceeding the month in which the request is received.  after the fifteenth day of a calendar month shall be effective on the first day of the preceding calendar month in which the request is received. The number of Subscribers is based on the total number of Subscribers enrolled on the first day of the current Rating Period. Retroactive cancellations will not be permitted by BCBSRI under these terms until it is first confirmed that no claims have been incurred subsequent to the requested retroactive cancellation effective date. This includes all incurred claims not yet received and/or paid by BCBSRI, at the time of notification by GROUP of such requested retroactive cancellations. For any retroactive termination request where a claim has been incurred, BCBSRI will use the receipt date of the request as the termination date, and GROUP agrees to pay the pro-rated Monthly Premium owed to BCBSRI for the portion of the month covered up to the termination date. Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility. GROUP agrees that BCBSRI shall have no liability to GROUP for health care services rendered to such Enrolled Members incurred before the effective date or after the termination date.