Significant Curtailment Without Loss of Coverage Sample Clauses
The 'Significant Curtailment Without Loss of Coverage' clause defines the rights and protections for individuals when there is a substantial reduction in the scope or value of their insurance or benefits, but the coverage itself is not entirely terminated. In practice, this clause typically applies when an employer or insurer makes major changes to a health plan, such as increasing deductibles or reducing covered services, yet continues to offer the plan in name. Its core function is to ensure that affected individuals are treated as if they have lost coverage for purposes such as qualifying for continuation coverage (like COBRA), thereby protecting them from being left without meaningful benefits due to significant but non-terminating changes.
POPULAR SAMPLE Copied 2 times
Significant Curtailment Without Loss of Coverage. If a Participant (or a Participant’s spouse or dependent) has a significant curtailment of coverage under a Benefit during a Period of Coverage that is not a loss of coverage (for example, there is a significant increase in the deductible, the co-pay, or the out-of-pocket cost sharing limit under an accident or health plan), the Plan shall permit the Participant to revoke his or her election for that coverage and, in lieu thereof, to elect to receive on a prospective basis coverage under another Benefit Package Option providing similar coverage. For purposes of this Plan, “similar coverage”, means coverage for the same category of Benefits for the same individuals. Coverage under a Benefit is significantly curtailed only if there is an overall reduction in coverage provided under the Benefit so as to constitute reduced coverage generally.
Significant Curtailment Without Loss of Coverage. If the Plan Administrator determines that a Participant’s coverage under a Benefit Package Option under this Plan (or the Participant’s Spouse’s or Dependent’s coverage under his or her employer’s plan) is significantly curtailed without a Loss of Coverage (for example, when there is a significant increase in the deductible, the co-pay, or the out-of-pocket cost-sharing limit under an accident or health plan during a Period of Coverage, the Participant may revoke his or her election for the affected coverage, and in lieu thereof, prospectively elect coverage under another Benefit Package Option that provides similar coverage. Coverage under a plan is “significantly curtailed” only if there is an overall reduction in coverage provided under the plan that constitutes reduced coverage generally.
Significant Curtailment Without Loss of Coverage. If the Plan Administrator determines that a Participant's coverage under a benefit package option under this Plan (or the Participants' Spouse's or Dependent's coverage under his or her employer's plan) is significantly curtailed without a Loss of Coverage (for example, when there is a significant increase in the deductible, the co-pay, or the out-of-pocket limit under a health plan) during a Period of Coverage, the Participant may revoke his or her election for the affected coverage, and in lieu thereof, prospectively elect coverage under another benefit package option that provides similar coverage (such as an HMO, but not the Health FSA). Coverage under a plan is deemed to be "significantly curtailed" only if there is an overall reduction in coverage provided under the plan so as to constitute reduced coverage generally.