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<br />2) Birth; <br /> <br />3) Adoption or placement for adoption; <br /> <br />c) The eligible employee, Subscriber or Dependent must complete and subrnit an <br />Enrollment or Status Change form within 31 days of the termination of other coverage <br />and provide proof of continuous coverage under the other plan; or within 31 days of the <br />date the Dependent becomes eligible (or within 60 days as required for newborns). If <br />an employee is eligible but not enrolled, the ernployee will also be required to enroll at <br />this time. <br /> <br />Employees and their Dependents who are eligible for coverage but not enrolled, shall be <br />eligible to enroll for coverage within 60 days following: <br /> <br />a) Termination of coverage under Medicaid or Children's Health Insurance Plan (CHIP) <br />due to loss of eligibility; or <br /> <br />b) Deternllnation of eligibility for premium assistance under Medicaid or CHIP. <br /> <br />c) The ernployee or Dependent must complete and subrnit an Enrollment or Status Change <br />form within 60 days of the date of the loss of Medicaid or CHIP coverage, and within <br />60 days of the determination of eligibility for prernium assistance under Medicaid or <br />CHIP. If an employee is eligible but not enrolled, the employee will also be required to <br />enroll at this time in order to cover an eligible Dependent. <br /> <br />Termination resulting from failure to pay premiums on a timely basis or termination of <br />coverage for cause (due to fraud, intentional misrepresentation, etc.) will not provide a <br />special enrollment period. <br /> <br />5.04 The eligibility requirements set forth in Part IV shall at all times control and no coverage contrary <br />thereto shall be effective. Coverage shall not be implied due to clerical or administrative errors if such <br />coverage would be contrary to Part IV. See also Section 17.05) <br /> <br />5.03.02 <br /> <br />5.03.03 <br /> <br />) <br /> <br />') <br /> <br />I <br /> <br />) <br /> <br />5.05 This Contract, at the sole option of AvMed, will not be accepted if at the time of initial offering to <br />Subscribing Group or, following re-enrollment, the total enrollrnent does not result in a predetermined <br />minirnum enrollment as established by AvMed. The required rninimum group enrollment is included in <br />the rate letter submitted to Subscribing Group. <br /> <br />A V -0 100-2009 <br />MP-5319 (10/09) <br /> <br />) <br /> <br />II <br />