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Agmt23 AETNA
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Agmt23 AETNA
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Last modified
3/28/2023 11:20:48 AM
Creation date
3/28/2023 11:19:57 AM
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Agreement
PROJECT NAME
AETNA Resources for Living -
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HHRC-EOC 02.10.2017 7 Evidence of Coverage <br />2) The specific date and time when Group coverage ends, which will be no sooner than <br />15 days after the Notice Confirming Termination of Coverage is mailed to you. <br />B. Reinstatement of the Contract after Cancellation <br />If Group’s EAP Services Agreement is cancelled for Group’s nonpayment of premiums, <br />then Plan will permit reinstatement of Group’s Agreement if Group pays the amounts owed <br />within 15 days of the date of the Notice Confirming Termination is mailed to Group. <br />C. Member Termination for Non-Eligibility <br />In addition to terminating the EAP Services Agreement, Plan may terminate a Member’s <br />coverage for any of the following reasons: <br /> Member no longer meets eligibility requirements established by Group and/or Plan; <br /> Member lives or works outside Plan’s service area and does not work inside Plan’s <br />service area (except for a child who is covered as a dependent). <br />Ending Coverage – Special Circumstances for Enrolled Family Members. <br />Enrolled Family Members terminate on the same date of termination as Group. If there is <br />a divorce, the spouse loses eligibility at the end of the month in which a final judgment or <br />decree of dissolution of marriage is entered. Dependent children lose their eligibility when <br />they reach the limiting age of 26 and do not qualify for extended coverage as a disabled <br />dependent. <br />D. Termination for Good Cause <br />Plan has the right to terminate your coverage under this EAP Plan in the following <br />situation: <br /> Fraud or Misrepresentation. Your coverage may be terminated if you knowingly <br />provide false information (or misrepresent a meaningful fact) on your enrollment form <br />or fraudulently or deceptively use services or facilities of Plan and/or Plan’s <br />participating Providers (or knowingly allow another person to do the same). <br />Termination is effective immediately on the date Plan mails the Notice of Termination, <br />unless Plan has specified a later date in that notice. <br />If coverage is terminated for the above reason, you forfeit all rights to enroll in the COBRA <br />Plan. <br />Under no circumstances will a Member be terminated due to health status or the need for <br />EAP Services. Any Member who believes his or her enrollment has been terminated due <br />to the Member’s health status or requirements for EAP Services may request a review of <br />REV: 03-10-23 MI <br />ATTY/AGR.2023.039/Aetna (EAP Services Agreement) (Page 31 of 42)
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