Cancellation and non-renewal of enrollment or subscription, New Dental Choice Plan

Thursday, May. 26th 2011 6:22 AM

An enrollment or a subscription may be cancelled or not renewed by Plan for the following reasons:  (a) Failure to pay the Membership Fee if the Subscriber has been duly notified and billed for the Fee and at least 15 days have elapsed since the date of notification. Cancellation of membership will be effective upon the date of mailing the notice of cancellation.  (b) Fraud or deception in the use of the discounted fee Membership or knowingly permitting such fraud or deception by another. Cancellation of membership will be effective upon the date of mailing the notice of cancellation;

(c) If at any time we determine that you intentionally gave us incomplete or incorrect material information and our decision to accept your enrollment was based, in whole or part, on that misinformation, we may cancel your membership. Cancellation of membership will be effective upon the date of mailing the notice of cancellation.

(d) If a Participating Provider is unable, after reasonable effort, to establish and maintain a satisfactory dentist-patient relationship with a Member, and Member declines to seek desired dental services from another Participating Provider. Notice of such termination must be in writing by the Plan and eligibility will cease fifteen (15) days after receipt of postage-paid mailing of such notice. Following termination, the Plan will refund any Membership Fee received by it on behalf of such Member during the period of one (1) month prior to such termination.

(e) Upon a Dependent’s no longer living with and financially dependent upon the Subscriber, as determined by the Internal Revenue Service. Cancellation of Dependent’s membership will be effective on the last day of the month for which a prepayment fee was made on behalf of the Dependent.

(f) If eligibility lapses while a Member is undergoing treatment for an ongoing condition, the Member will have a thirty (30) day grace period for full reinstatement of eligibility without a lapse in coverage. (g) In the event the proper Membership Fee amount is paid after cancellation of the Subscriber, the Plan will reinstate the Subscriber without requiring a new application unless the Plan shall, within twenty (20) business days: 1) refund the payment made or 2) issue to the Subscriber a new enrollment form. Covered Services in Progress will continue until the Services are completed. A Subscriber who believes that his or her membership has been cancelled or non-renewed because of his or her dental health status or requirements for dental care services may request that such action be reviewed by the Director of the Department of Managed Health Care by contacting the Department at the telephone number stated in Paragraph 17 below. If after canceling this Agreement for nonpayment of the required Membership Fee Plan receives the Membership Fee within 30 days, Plan shall reinstate the Member as though the cancellation had never occurred; provided, however, that Plan need not reinstate the Member if payment is not received within 30 days of the issuance of the notice of cancellation; in such a case, a new application will be required and if accepted the original contract will be reinstated. The notice of cancellation will clearly state these conditions and procedures.

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Posted on Thursday, May. 26th 2011 6:22 AM | by Share of Cost | in Share of Cost | No Comments »

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