Reso 2010-1529 - Laserfiche WebLink

Home Browse Search

1 addendum to this Contract. An additional charge will apply to all late premium payrnents. See Section 17.17 ) 7.02 Grace period. This Contract bas a ten-day grace period. This provision means that if any required premium is not paid on or before the date it is due, it must be paid during the following grace period. During the grace period, the Contract will stay in force. However, if payment is not received by the last day of the grace period, termination of this Contract for nonpayment of the premium will be retroactive to 12:00 a.m. (midnigbt) on the last day of the month for which the premium was paid. Note: Certain provisions in Section 7.01 may apply if the parties have executed an addendum affecting premium payments. 7.03 Maximurn Co-payments. Total annual Co-payments are limited as described in your Schedule of Benefits. The Co-payment limits apply to Co-payments made for all core benefits contained in this Contract, and do not apply to services provided under the Prescription Medication, Vision and other amendments. 7.04 Member shall pay premiums, applicable supplernental charges, or Co-payments as provided in this Contract and applicable Schedule of Benefits. Ifthe Member fails to pay the applicable premiums, upon 10 days written notice from AvMed to the Member, the Member's rights hereunder shall be terminated. Consideration for reinstaternent with AvMed shall require a new application, and any re-enrollrnent shall be at the sole discretion of AvMed and shall not be retroactive. 7.05 Refund of premiums paid to AvMed by the Subscribing Group for any Member after the date on which that Member's eligibility ceased or the Member was terminated shall be limited to the total excess premium amounts paid up to a maximum of 60 days from the date of such ineligibility or termination, provided there are no Claims incurred subsequent to the effective date of termination. No retroactive terminations of Members will be made heyond 60 days from notification of the terminating event. 7.06 In the event of the retroactive termination of an individual Member (as described in Subsections 9.01.02 and 9.02.01 of this Contract), AvMed shall not be responsible for medical expenses incurred by AvMed in providing benefits to the Member under the terms of this Contract after the effective date of termination (due to the Subscribing Group's nonpayment of premiums or failure to tirnely notifY AvMed of Member ineligibility). At the discretion of AvMed, and based on tbe facts availahle at the time, AvMed may pursue either the Subscribing Group or the Member for payment. _I ) VIII. CONVERSION 8.0 I A Subscriber or covered Dependent whose coverage under the Subscribing Group Contract has been terminated for any reason, including discontinuance of the Subscribing Group Contract in its entirety or with respect to a covered class, and who has been continuously covered under the Subscribing Group Contract, and under any group health maintenance contract providing similar henefits which it replaces, for at least 3 months inunediately prior to termination, shall be entitled, subject to the exceptions contained herein, to have issued to hirn or her a Conversion Contract (see Section 3.11), unless there is a replacement of discontinued group coverage by sirnilar group coverage within 31 days. 8.01.01 The converting Subscriber and each of the eligible Dependents of the Subscriber who are converting must be Members of the Plan in good standing on the date when their coverage terminates under this Group Contract, and all such Subscribers and Dependents, after cornplying with Subsection 8.01.02 below, shall be covered under the Individual Conversion Contract. 13 A V -Gl 00-2009 MP-5319 (10/09)