COBRA - Cause for Termination

Your coverage with MCHCP shall terminate if any one of the following events occurs:

• You no longer meet the eligibility requirements set forth in this handbook including, without limitation, upon termination of the subscriber from employment; divorce or legal separation from the subscriber; or when a dependent child reaches the limiting age.
• You fail to pay required premiums. Note: In the event that the Plan has not received payment of premium at the end of the 31 day grace period, you will be retroactively terminated to the date covered by your last paid premium. You will be responsible for the value of services rendered after the retroactive termination date (including but not limited to the grace period).
• You knowingly misrepresenting or giving false information on any enrollment form which is material to the Plan’s acceptance of such enrollment.
• You participate in fraudulent or criminal behavior, including but not limited to:
  • Performing an act or practice that constitutes fraud or intentionally misrepresenting material facts including using your identification card to obtain goods or services which are not prescribed or ordered for you or to which you are otherwise not legally entitled. In this instance, coverage for the subscriber and all dependents will be terminated.
  • Allowing any other person to use you your identification card to obtain services. If a dependent allows any other person to use his/her identification card to obtain services, the coverage of the dependent who allowed the misuse of the card will be terminated. If the subscriber allows any other person to use his/her identification card to obtain services, the coverage of the subscriber and his/her dependents will be terminated.
  • Threatening or perpetrating violent acts against the Plan or an employee of the Plan. In this instance, coverage for the subscriber and all dependents will be terminated.

  If your coverage under this agreement is terminated under this section, all rights to receive covered services shall cease as of the date of termination.
  
  Your coverage cannot be terminated on the basis of the status of your health or the exercise of your rights under the Plan’s grievance and complaint procedures. The Plan may not terminate an agreement solely for the purpose of effecting the disenrollment of an individual member for either of these reasons.
  
  If the member receives covered services after the termination of coverage, the plan may recover the contracted charges for such covered services from you or the provider, plus its cost to recover such charges, including attorneys’ fees.
  
  Under certain circumstances, members may be eligible for continuation of coverage benefits or to convert to another policy.