Common use of Loss of Other Coverage Clause in Contracts

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.