By the Member. If it is proven that the Member attempted or committed fraud under this Certificate to obtain benefits or payment or if the Member makes an intentional misrepresentation of material fact in the application for coverage under this Certificate, the Member’s coverage will be terminated subject to fifteen (15) days written notice to the Subscriber and the Group. This decision may be appealed through the PPO’s established Complaint procedure as set forth in Section 5 of this Certificate. A Member whose coverage is terminated under this Section for fraud or material misrepresentation may not apply to the PPO for health coverage for a period of thirty-six (36) months following such termination.
Appears in 2 contracts
Sources: Direct Access Preferred Provider Organization Contract, Direct Access Preferred Provider Organization Contract