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<br />") <br /> <br />') <br /> <br />CJ <br /> <br />) <br /> <br />8.01.02 A completed Status Change form requesting conversion shall be sent to AvMed or its <br />designated administrator with the Erst applicable premium and shall be received by AvMed <br />or its designated administrator not later than 63 days after the date of termination of this <br />Group Contract. <br /> <br />8.01.03 Dependents may not convert without the Subscriber except: <br /> <br />a) In the event of the death of the Subscriber, Dependents are permitted an automatic <br />conversion privilege and must comply with Subsection 8.01.02 above. <br /> <br />b) A spouse whose coverage would terminate, or a spouse and children whose coverage <br />would otherwise terminate at the same time, or a child with respect to himself, by <br />reason of ceasing to be a qualified family member, rnay convert and must cornply with <br />Subsection 8.01.02 above. <br /> <br />c) A former spouse whose coverage would otherwise terminate because of annulment or <br />dissolution of marriage may convert if the former spouse is dependent for [mancial <br />support. The former spouse must comply with Subsection 8.01.02 above and must <br />provide written evidence of financial dependence upon request of AvMed. <br /> <br />8.01.04 Payment for health care services rendered to a Member after termination and prior to <br />conversion shall be the responsibility of the Mernber. When the conversion application has <br />been timely completed (within 63 days after termination of the Group Contract) and the first <br />premium due has been paid, AvMed shall reimburse the Subscriber for any payment made by <br />the Subscriber for covered Medical Services under the converted Contract. <br /> <br />8.01.05 A new Conversion Contract is established upon application and payrnent of the premium on <br />the day following the Member's termination from group coverage (due to ineligibility under <br />the Group Contract) and continues through the end of the calendar year. The Contract Year, <br />upon renewal, shall be the calendar year. <br /> <br />8.01.06 Individual Conversion Contracts may not include supplemental benefits, notwithstanding the <br />supplemental benefits included under this Subscribing Group Contract, and may in other <br />respects, as determined by AvMed, differ from this Group Contract. <br /> <br />8.01.07 The conversion privilege will not apply to a Subscriber or covered Dependent if termination <br />of coverage under this Contract occurred for any of the following reasons: <br /> <br />a) Failure to pay any required premium or contrihution unless such nonpayment of <br />premium was due to acts of an employer or person other than the individual; <br /> <br />b) Replacement of any discontinued group coverage by similar group coverage within 31 <br />days; <br /> <br />c) Fraud or material misrepresentation in applying for any benefits under this Contract <br />(see Subsection 9.01.05); <br /> <br />d) Willful and knowing misuse of AvMed's identification card by the Member; <br /> <br />e) Willfully and knowingly furnishing incorrect or incornplete information to AvMed for <br />the purpose of fraudulently obtaining coverage or benefits from AvMed; or <br /> <br />f) Termination from coverage under this Contract in accordance with Subsection 9.01.05. <br /> <br />8.02 Conversion after Continuation Coverage. When continuation coverage as provided under the <br />provisions of the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) expires, the <br />Subscriber or covered Dependent may be eligible for conversion coverage and may apply by completing <br />an application for an Individual Conversion Contract, subject to the conditions described in this Part <br /> <br />14 <br /> <br />AV-0100-2009 <br />MP-5319 (10/09) <br />