Rescission of Coverage Clause Samples
The Rescission of Coverage clause allows an insurer to retroactively cancel an insurance policy, typically when it is discovered that the policyholder provided false or misleading information during the application process. In practice, this means that if material misrepresentations or omissions are found, the insurer can void the policy as if it never existed, potentially denying all claims made under it. This clause serves to protect insurers from fraud and ensures that coverage is only provided when accurate and complete information has been disclosed.
Rescission of Coverage. We reserve the right to Rescind coverage under this Contract or coverage for any person covered under this Contract as permitted by law. We may only Rescind the Contract or coverage of a person covered under the Contract if you or another person on your behalf commits fraud or you make an intentional misrepresentation of material fact in applying for coverage or benefits. Only fraudulent misstatements on the Enrollment Form may be used by us to void coverage or deny any claim for loss incurred or disability, if discovered after two years from your Effective Date. We will provide at least 45 days advance written notice to the Contractholder of our intent to Rescind coverage. Rescission of coverage is considered an Adverse Benefit Determination and is subject to the Adverse Benefit Determination review standards described in the CLAIMS PROCESSING section and the appeal procedures described in the APPEAL AND GRIEVANCE PROCESS section.
Rescission of Coverage. Any omission of a material fact, or fraudulent misstatement, or intentional misrepresentation of a material fact on the Subscriber’s application will result in the cancellation of Your coverage (and/or Your Dependent(s)) coverage retroactive to the Effective Date. In the event of such cancellation, Blue Cross and Blue Shield of Texas may deduct from the premium refund any amounts made in claim payments during this period and You may be liable for any claims payment amount greater than the total amount of premiums paid during the period for which cancellation is effected. At any time when BCBSTX is entitled to rescind coverage already in force, BCBSTX may at its option make an offer to reform the policy already in force. This reformation could include, but not be limited to, the addition of exclusion riders and a change in the rating category/level. In the event of reformation, the policy will be reissued retroactive in the form it would have been issued had the misstated or omitted information been known at the time of application.
Rescission of Coverage. Section 6.54 Definition of Rescission of Coverage 6.19 Section 6.55 Notice of Rescission 6.19 Section 6.56 Deadline for Filing an Appeal 6.19
Rescission of Coverage. Aetna may rescind the covered person’s coverage if the covered person, or the person seeking coverage on the covered person’s behalf: • Performs an act, practice or omission that constitutes fraud; or • Makes an intentional misrepresentation of material fact. The covered person will be given 30 days advance written notice of any rescission of coverage. As to medical. pediatric dental, pediatric vision care, and prescription drug coverage only, the covered person has the right to an internal appeal with Aetna and/or the right to a third party review conducted by an independent External Review Organization if the covered person’s coverage under this Policy is rescinded retroactive to its Effective Date. Certain services, such as inpatient stays, certain tests, procedures, outpatient surgery, therapies and equipment, and prescribed medications require precertification by Aetna. Precertification is a process that helps the covered person and their physician determine whether the services being recommended are covered medical expenses under the plan. It also allows Aetna to help the covered person’s provider coordinate the covered person’s transition from an inpatient setting to an outpatient setting (called discharge planning), and to register the covered person for specialized programs or case management when appropriate. Precertification is not the same requirement as a plan’s Referral Requirement. A plan’s referral requirement and process is separate from the plan’s precertification requirement and process. Refer to the Schedule of Benefits for the plan’s Referral Requirement. The plan’s Referral Requirement must be followed in addition to the plan precertification process. The covered person does need to precertify services provided by a non-preferred care provider. Preferred care providers will be responsible for obtaining necessary precertification for the covered person. Since precertification is the provider’s responsibility, there is no additional out-of-pocket cost to the covered person as a result of a preferred care provider's failure to precertify services. When a covered person goes to a non-preferred care provider it is the covered person’s responsibility to obtain precertification from Aetna for any services, treatments, procedures, visits or supplies on the precertification list below. If the covered person does not precertify, benefits may be reduced. The list of services requiring precertification appears later in this section. If the covere...
Rescission of Coverage. A rescission of coverage is a cancellation or discontinuance of coverage that has retroactive effect, meaning that it will be effective back to the time that you should not have been covered by the Plan. The Plan may rescind your coverage for fraud or intentional misrepresentation of a material fact after the Plan provides you with 30 days advance written notice of that rescission of coverage. However, the following situations will not be considered rescissions of coverage and do not require the Plan to give you 30 days advance written notice: • When the Plan terminates your coverage retroactive to the date you lose eligibility for coverage, if there is a delay in administrative record keeping between the date you lose eligibility and the date the Plan is notified of your loss of eligibility; • When the Plan retroactively terminates your coverage because you fail to make timely self-payments for your coverage; or • When any unintentional mistakes or errors result in you or your Dependents being covered by the Plan when you should not have been covered; in this instance, the Plan will cancel your coverage prospectively—for the future—once the mistake is identified.