When Coverage May Be Changed or Canceled Sample Clauses
The "When Coverage May be Changed or Canceled" clause defines the circumstances under which an insurance policyholder or the insurer can modify or terminate the coverage. Typically, this clause outlines specific events, such as non-payment of premiums, material misrepresentation, or changes in risk, that may trigger a change or cancellation. It may also specify required notice periods and procedures for either party to follow. The core function of this clause is to provide clear guidelines and protections for both parties, ensuring that changes or cancellations are handled fairly and transparently.
When Coverage May Be Changed or Canceled. (a) Changes Due to a Life Event. After the initial enrollment period and outside of any open enrollment period, an employee may elect to change health or dental coverage (including adding or canceling coverage) and any applicable employee contributions in the following situations (as long as allowed under the applicable provisions, regulations, and rules of the federal and state law in effect at the beginning of the plan year). The request to change coverage must be consistent with a change in status that qualifies as a life event, and does not include changing health or dental plans, which may only be done under the terms of Section E.I above. Any election to add coverage must be made within thirty (30) days following the event, and any election to cancel coverage must be made within sixty (60) days following the event. (An employee and a retired employee may add dependent health or dental coverage following the birth of a child or dependent grandchild, or following the adoption of a child, without regard to the thirty (30) day limit.) These life events for both employees and retirees are:
(i) A change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment;
(ii) A change in number of dependents including birth, death, adoption, and placement for adoption.
(iii) A change in employment status of the employee, or the employee's or retiree's spouse, or dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence, a change in worksite, and a change in working conditions (including changing between part-time and full-time or hourly and salary) of the employee, the employee's or retiree's spouse or dependent which results in a change in the benefits they receive under a cafeteria plan or a health or dental plan.
(iv) A dependent ceasing to satisfy eligibility requirements for coverage due to attainment of age, student status, marital status, or other similar circumstances.
(v) A change in place of residence of the employee, retiree or their spouse, or dependent.
(vi) Significant cost or coverage changes (including coverage curtailment and the addition of a benefit package).
(vii) Family Medical Leave Act (FMLA) leave.
(viii) Judgments, decrees or orders.
(ix) A change in coverage of a spouse, or dependent under another Employer's plan.
(x) Open enrollment under the plan of another Employer.
(xi) Health Insurance Portability and Acc...
When Coverage May Be Changed or Canceled. Changes Due to a Life Event. After the initial enrollment period and outside of any 39 open enrollment period, a faculty member may elect to change health or dental coverage 40 (including adding or canceling coverage) and any applicable faculty member 41 contributions in the following situations (as long as allowed under the applicable 42 provisions, regulations, and rules of the federal and state law in effect at the beginning of 43 the plan year). 44 1 The request to change coverage must be consistent with a change in status that qualifies 2 as a life event, and does not include changing health or dental plans, which may only be 3 done under the terms of Section 5A above. Any election to add coverage must be made 4 within thirty (30) days following the event, and any election to cancel coverage must be 5 made within sixty (60) days following the event. (A faculty member and a retired faculty 6 member may add dependent health or dental coverage following the birth of a child or 8 (30) day limit.) These life events (for both faculty members and retirees) are:
When Coverage May Be Changed or Canceled