Loss of Other Coverage Sample Clauses

The "Loss of Other Coverage" clause defines how an insurance policy responds when the insured loses other insurance coverage that previously provided similar protection. Typically, this clause outlines the conditions under which the current policy will become primary or adjust its benefits if the insured's other coverage ends, such as through cancellation or expiration. Its core practical function is to ensure continuous protection for the insured and to clarify the insurer's obligations in the event that overlapping or supplementary coverage is no longer available, thereby preventing gaps in coverage and potential disputes over responsibility.
Loss of Other Coverage. Any individual eligible as a Subscriber or Dependent who did not enroll when initially eligible may enroll if each of the following is true, and if HMO receives completed enrollment application/change forms and applicable Premium payments within thirty-one (31) days after the date coverage ends or after a claim is denied due to reaching the lifetime limit under another Health Benefit Plan, self-funded employer Health Benefit Plan, or other health insurance coverage (collectively referred to in this subsection as “Prior Health Benefit Plan”): (1) You or any eligible Dependent was covered under a Prior Health Benefit Plan at the time You were initially eligible to enroll; (2) You declined enrollment, in writing, for Yourself and/or Your Dependent(s) at the time of initial eligibility, stating that coverage under a Prior Health Benefit Plan was the reason for declining enrollment; and (3) You or any eligible Dependent lost coverage under a Prior Health Benefit Plan as a result of: (a) termination of employment; (b) a reduction in the number of hours of employment; (c) termination of Your Prior Health Benefit Plan coverage; (d) You or Your Dependent incurring a claim that would meet or exceed a lifetime limit on all benefits under Prior Health Benefit Plan coverage; (e) the Prior Health Benefit Plan no longer offering any benefits to the class of similarly situated individuals that include You or Your Dependent(s); (f) if coverage was through a health maintenance organization, You or Your Dependent(s) no longer residing, living, or working in the Service Area of the health maintenance organization and no other benefit option being available; (g) termination of contribution toward the Premium made by the former employer; (h) Dependent status ending (for example, due to death of a spouse, divorce, legal separation or reaching the maximum age to be eligible as a Dependent child under the Prior Health Benefit Plan); or (i) expiration of the continuation of coverage period of the Prior Health Benefit Plan under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or under the continuation provisions of the Texas Insurance Code. The Effective Date of Coverage under this subsection is the day after prior coverage terminated.
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Loss of Other Coverage. A loss of coverage due to an individual’s failure to pay Premiums on a timely basis (including COBRA Premiums), or termination of coverage for cause (fraud or intentional misrepresentation of material fact), will not trigger a special enrollment period. i. If you lose coverage due to any of the following triggering events, you and your eligible dependents can apply for coverage within 60 days after the date of the triggering event. If you apply and are enrolled by the 15th of the month, your new coverage will be effective on the first day of the following month. If you apply and are enrolled between the 16th and the last day of the month, your new coverage will be effective on the first day of the second following month. 1) termination of employment or reduction in hours of employment 2) termination of employer Premium contributions; 3) change in dependent status due to divorce, annulment or the death of a covered employee whose employment afforded dependent coverage; 4) relocation out of an HMO service area (you must provide proof of having minimum essential coverage, as defined by the Affordable Care Act (ACA), for one or more days during the 60 days immediately preceding the date of the move);
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Loss of Other Coverage i. For triggering events described in Section 4.3a.i, if we receive the required documentation by the 15th of the month, coverage will be effective on the first day of the following month. If received between the 16th and the last day of the month, coverage will be effective on the first day of the second following month. ii. For triggering events described in Section 4.3a.ii, if we receive the required documentation before or on the date of the triggering event, coverage will be effective on the first day of the month following the event. If received after the date of the triggering event, coverage will be effective on the first day of the month following receipt of the required information.
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Loss of Other Coverage i. If a loss of coverage results from any of the following triggering events an eligible individual, or an eligible individual on behalf of himself and his eligible dependents, may elect to enroll in the Plan within 60 days after the date of the triggering event: 1) termination of employment or reduction in hours of employment 2) termination of employer Premium contributions; 3) change in dependent status due to divorce, annulment or the death of a covered employee whose employment afforded dependent coverage; 4) relocation out of an HMO service area (you must provide proof of having minimum essential coverage, as defined by the Affordable Care Act (ACA), for one or more days during the 60 days immediately preceding the date of the move);
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Loss of Other Coverage i. If a loss of coverage results from any of the following triggering events an eligible individual, or an eligible individual on behalf of himself and his eligible dependents, may elect to enroll in the Plan within 60 days after the date of the triggering event: 1) Termination of employment or reduction in hours of employment 2) Termination of employer Premium contributions; 3) Change in dependent status due to divorce, annulment or the death of a covered employee whose employment afforded dependent coverage; 4) Relocation out of an HMO service area (you must provide proof of having minimum essential coverage, as defined by the ACA, for one or more days during the 60 days immediately preceding the date of the move); 5) A bankruptcy filing by an employer from which a covered employee has retired at the time of the bankruptcy filing. ii. If any of the following triggering events occur, an eligible individual, or an eligible individual on behalf of himself and his eligible dependents may elect to enroll in the Plan within 60 days before or 60 days after the date of the triggering event: 1) Loss of minimum essential coverage (as defined by the Affordable Care Act); 2) The last day of an individual’s enrollment in a non-calendar year group health plan or individual health insurance coverage, even if the individual has the option to renew; 3) Loss of pregnancy-related Medicaid coverage; 4) Loss of medically needy Medicaid coverage (no more than once a year). iii. Loss of coverage due to an individual’s failure to pay Premiums on a timely basis (including COBRA Premiums), or termination of coverage for cause (fraud or intentional misrepresentation of material fact), will not trigger a special enrollment period.
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Related to Loss of Other Coverage

  • Other Coverage Borrower shall provide to Lender evidence of such other reasonable insurance in such reasonable amounts as Lender may from time to time request against such other insurable hazards which at the time are commonly insured against for property similar to the subject Property located in or around the region in which the subject Property is located. Such coverage requirements may include but are not limited to coverage for earthquake, acts of terrorism, business income, delayed business income, rental loss, sink hole, soft costs, tenant improvement or environmental.

  • Other Covered Persons Other than the Placement Agent, the Company is not aware of any person (other than any Issuer Covered Person) that has been or will be paid (directly or indirectly) remuneration for solicitation of purchasers in connection with the sale of any Securities.

  • Correction of Errors and Omissions; Other Liabilities (a) In the event any bookkeeping omissions or errors are discovered in preparing any pro forma statement or in completing the transfers and assumptions contemplated hereby, the parties hereto agree to correct such errors and omissions, it being understood that, as far as practicable, all adjustments will be made consistent with the judgments, methods, policies or accounting principles utilized by the Failed Bank in preparing and maintaining Accounting Records, except that adjustments made pursuant to this Section 8.2(a) are not intended to bring the Accounting Records of the Failed Bank into accordance with generally accepted accounting principles. (b) If the Receiver discovers at any time subsequent to the date of this Agreement that any claim exists against the Failed Bank which is of such a nature that it would have been included in the liabilities assumed under Article II had the existence of such claim or the facts giving rise thereto been known as of Bank Closing, the Receiver may, in its discretion, at any time, require that such claim be assumed by the Assuming Institution in a manner consistent with the intent of this Agreement. The Receiver will make appropriate adjustments to the pro forma statement provided by the Receiver to the Assuming Institution pursuant to Section 8.1 as may be necessary.

  • Fire and Other Casualty Tenant shall immediately notify Landlord of any fire or other casualty at the Premises. If the Premises is damaged by fire or other casualty, but not so as to render the Premises untenantable, the Landlord shall repair the same as speedily as practicable, but the Tenant’s obligation to pay the rent hereunder shall not cease. If, in the opinion of the Landlord, the Premises be so extensively and substantially damaged as to render it untenantable, then the rent shall cease until such time as the Premises shall be made tenantable by the Landlord. However, if, in the opinion of the Landlord, the Premises be totally destroyed or so extensively and substantially damaged as to require practically a rebuilding thereof, then Landlord shall either: (a) notify Tenant that the Lease is terminated; or (b) notify Tenant that Landlord intends to rebuild the Premises, in which case, rent shall be abated from the date of the fire or other casualty until issuance of a certificate of occupancy for the Premises, during which time Tenant may terminate this Lease by written notice to Landlord. In no event however, shall the provisions of this clause become effective or be applicable, if the fire or other casualty results from the carelessness, negligence or improper conduct of the Tenant or the Tenant’s agents, employees, guests, contractors, licensees, invitees, subtenants, assignees or successors. In such case, the Tenant’s liability for the payment of the rent and the performance of all the covenants, conditions and terms hereof on the Tenant’s part to be performed shall continue and the Tenant shall be liable to the Landlord for the damage and loss suffered by the Landlord. Tenant shall repair all damages caused to the Premises by vandalism or burglary.

  • Breach of Other Covenants Any of the Loan Parties shall default in the observance or performance of any other covenant, condition or provision hereof or of any other Loan Document and such default shall continue unremedied for a period of ten (10) Business Days;