Termination of Coverage

Termination of Coverage

 
Loss of Eligibility for Group Coverage

When your eligibility for group coverage ends, your coverage in this health plan will be terminated as of the date you lose eligibility. You will not be eligible for coverage in this health plan when any one of the following situations occurs.

  • Subscriber’s Group Eligibility Ends. Your coverage in this health plan will end when the subscriber loses eligibility for the group’s health care coverage. This means: the subscriber’s hours are reduced; or the subscriber leaves the job; or the subscriber no longer meets the rules that are set by the group for group coverage. (You will also lose eligibility for group coverage if you are an enrolled dependent when the subscriber dies.)
  • Your Dependent Status Ends. Your coverage in this health plan will end when you lose your status as a dependent under the subscriber’s group membership. In this case, you may be able to enroll in a Blue Cross and Blue Shield health plan or a health plan offered by Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. For help, you can call the Blue Cross and Blue Shield customer service office. They will tell you which health plans are available to you.
  • You Move Out of Your Service Area. Your coverage in this health plan will end when you move permanently out of your service area. In this case, if you are still eligible for group coverage, you may be eligible to transfer your coverage to another health plan that is offered by your group. (Contact your plan sponsor for help.) Or, if you are not eligible for group coverage, you may be able to enroll in another Blue Cross and/or Blue Shield Plan’s HMO plan. For help, you can call the Blue Cross and Blue Shield customer service office. They will help you with your options.
  • You Turn Age 65 and Become Eligible for Medicare. Your coverage in this health plan will end when you reach age 65 and become eligible for Medicare (Part A and Part B). However, as allowed by federal law, the subscriber (and the spouse and/or dependents) may have the option of continuing coverage in this health plan when the subscriber remains as an actively working employee after reaching age 65. You should review all options available to you with the plan sponsor. (Medicare eligible subscribers who retire and/or their spouses are not eligible to continue coverage in this health plan once they reach age 65.)
  • Your Group Cancels This Health Plan. Your coverage in this health plan will end when the group terminates (or does not renew) this health plan.
Termination of Group Coverage

Your coverage in this health plan will not be canceled because you are using your coverage or because you will need more covered services in the future. Your coverage in this health plan will be cancelled only when one of the following situations occurs.

  • You Voluntarily Cancel. Your coverage in this health plan will be cancelled when the subscriber chooses to cancel his or her group membership as permitted by the plan sponsor.
  • You Commit Misrepresentation or Fraud to Blue Cross and Blue Shield. Your coverage in this health plan will be canceled if you have committed misrepresentation or fraud to Blue Cross and Blue Shield. For example, you gave false or misleading information on the enrollment form. Or, you misused your ID card by letting another person who was not enrolled for coverage in this health plan attempt to get coverage. In this case, the termination of your coverage may go back to your effective date or, it may go back to the date of the misrepresentation or fraud. The termination date will be determined by Blue Cross and Blue Shield, subject to applicable federal law. Or, in some cases Blue Cross and Blue Shield may limit your benefits.
  • You Commit Acts of Physical or Verbal Abuse. Your coverage in this health plan will be canceled if you commit acts of physical or verbal abuse that pose a threat to health care providers or to other members of Blue Cross and Blue Shield or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc., and these acts are not related to your physical condition or mental condition.
  • You Fail to Comply With Plan Provisions. Your coverage in this health plan will be canceled if you fail to comply in a material way with any provision of this health plan. For example, if you fail to provide information that Blue Cross and Blue Shield requests related to your coverage in this health plan, Blue Cross and Blue Shield may terminate your coverage.