State Continuation Clause Samples
State Continuation. State continuation is available only if the Group is not subject to continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 and any amendments thereto. The Subscriber or the Dependent requesting continuation must have been continuously covered under this Benefit Plan (or
1. A Subscriber or a Dependent may be entitled to continue the coverage under this Benefit Plan when eligibility for coverage ends because of:
a. the death of the Subscriber;
b. the termination of the Subscriber’s active employment; or
c. the divorce of the Subscriber.
2. Continuation of coverage for a Subscriber or a Dependent is not available if:
a. within thirty-one (31) days of termination of coverage, the Subscriber or the Dependent is or could have been covered by other group coverage or a government-sponsored health plan such as Medicare or Medicaid;
b. the coverage under this Benefit Plan terminated due to fraud or the failure to pay any required contribution to premium; or
c. the Subscriber or the Dependent is eligible for continuation of coverage under COBRA. To elect continuation of coverage under this section, the Subscriber or the Dependent must notify the Group in writing of the election to continue this Benefit Plan and must pay any required contribution to the Group in advance. The initial contribution must be paid no later than the end of the month following the month in which the event occurred that made the Subscriber or the Dependent eligible. If a Dependent is eligible due to divorce, the event shall be deemed to have occurred on the date of the judgment of divorce. A form to continue coverage is available from and should be obtained from the Group.
3. Continuation of insurance under the Group Benefit Plan for any Subscriber or Dependent shall terminate on the earliest of the following dates:
a. twelve (12) calendar months from the date coverage would have otherwise ended;
b. the date ending the period for which the Subscriber or the Dependent makes the last required premium contribution for the coverage;
c. the date the Subscriber or the Dependent becomes or is eligible to become covered for similar benefits under any arrangement of coverage for individuals in a group, whether insured or uninsured, including Medicare of Medicaid;
d. the date on which the Group terminated this Benefit Plan;
e. the date on which an enrolled Subscriber or Dependent of a health maintenance organization legally resides outside the service area of the Compa...
State Continuation. This section (State Continuation) is available only if the Group is not subject to Continuation of Coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 and any amendments thereto. A Subscriber or covered Dependent whose coverage under this Benefit Plan ends because of: 1) Subscriber’s death; or 2) Subscriber’s termination of active employment; or 3) because of the divorce of the Subscriber or a covered Member, may be entitled to continue the coverage under this Benefit Plan. The Subscriber or Dependent requesting continuation must have been continuously covered under this Benefit Plan (or another group policy that this Benefit Plan replaced) for the three (3) consecutive months immediately preceding the date this coverage would otherwise have ended. the Covered Person, within thirty-one (31) days of termination of coverage, is or could have been covered by other Group coverage or a government sponsored health plan such as Medicare or Medicaid, or Group; or the Subscriber’s or Member’s coverage under this Benefit Plan terminated due to fraud or failure to pay his required contribution to premium; or the Covered Person is eligible for continuation of coverage under COBRA. To elect continuation of coverage under this section, the Subscriber or Member must notify the Group in writing of his election to continue this Group health coverage and must pay any required contribution to the Group in advance. The initial contribution must be paid no later than the end of the month following the month in which the event occurred which made the Subscriber or Member eligible. (If the Dependent is eligible due to divorce, the event shall be deemed to have occurred on the date of the judgment of divorce.) A form to continue coverage is available from the Group. Continuation of insurance under the Group policy for any Covered Person shall terminate on the earliest of the following dates: twelve (12) calendar months from the date coverage would have otherwise ended; or the date ending the period for which the Subscriber or Dependent makes his last required premium contribution for the coverage; or the date the Subscriber or Member becomes or is eligible to become covered for similar benefits under any arrangement of coverage for individuals in a Group, whether insured or uninsured, inc luding Medicare of Medicaid; or the date on which the Group policy is terminated; or the date on which an enrolled Member of a health maintenance organizati...