WHEN COVERAGE STOPS
Termination of Group Contract.
Termination on Notice. Either Kaiser Permanente or your Group may terminate the Group contract by giving the other party notice.
If we terminate our contract with your Group for any reason we may:
1. Offer you conversion to non-group membership; OR
2. Continue coverage if you are pregnant, hospitalized or in a skilled nursing facility on the date of termination. If you are pregnant, you will receive obstetrical and newborn care until you are discharged from the hospital. If you are hospitalized or in a skilled nursing facility, you will receive all benefits for the conditions for which you are confined, until your benefits are exhausted, or for 90 days from the termination date, whichever occurs first. You must pay any applicable Supplemental Charges.
If your Group terminates its contract with us, the coverage of all members enrolled through your Group will end on the date the group contract terminates.
Termination for Non-Payment.
If we terminate our contract with your Group because of non-payment of monthly charges, the coverage of all members enrolled through your Group will end on the date the group contract ends. Kaiser Permanente may elect not to allow conversion to non-group membership.
Loss of Eligibility.
Except as provided under Continuation Of Coverage below, coverage stops as follows:
For Subscriber and Dependents.
Group coverage stops for a subscriber and all enrolled dependents when the subscriber stops being eligible for group coverage.
For Dependents Only.
Whenever your dependent stops being eligible as your dependent, you must notify your Group of the disqualifying event and disenroll the dependent from your coverage. Dependents may be eligible for continuation of coverage as described below.
Spouses lose eligibility as follows:
In the event of a divorce, your spouse loses eligibility at the end of the month in which the divorce is final.
Children lose eligibility as follows:
At the end of the month in which your child is no longer dependent or marries, regardless of age; or at the end of the month or the end of the calendar year in which your child reaches the age limit(s) set by your Group or ceases to meet any of the other eligibility requirements for dependency status described below.
Prior to the date on which your child's coverage is expected to end because of age, we will send you a notice at your last address on record to remind you that your child will soon lose eligibility as a dependent. Your child may be eligible to continue Kaiser Permanente coverage as described in Continuation of Coverage. However, such coverage is not automatic. You must arrange continued coverage through Kaiser Permanente or your Group.
If you fail to respond to our notice in the time allowed and/or to choose a method of continuing your child's Kaiser Permanente coverage, your child's coverage will be automatically canceled on the last day of the month/year in which he/she reaches the dependent/student age limit of your Group. Non-Member Rates must be paid for any services received after that date.
Termination of Specific Members.
We may cancel your membership upon 15 days' written notice for any of the following reasons:
1. If you fail to pay within 15 days of notice any amount owed to Kaiser Permanente, designated Hospitals or Medical Group.
2. If you are disruptive, unruly or abusive to the extent that the ability of Kaiser Permanente, designated Hospitals or Medical Group to provide services to you or to other members is seriously impaired.
3. If you fail to establish or maintain a satisfactory doctor-patient or hospital-patient relationship after Medical Group and designated Hospitals have made reasonable efforts to promote such a relationship.
4. If you misrepresent your membership status or coverage or knowingly misuse your identification card or permit another person to make such a misrepresentation or misuse.
5. If you knowingly give incorrect or incomplete enrollment information.
6. If you alter a prescription or knowingly present an invalid prescription.
7. If you fail to provide Kaiser Permanente with notice of a change in family status or Medicare coverage status that affects eligibility or benefits.
Cancellation of membership for any one of these reasons, applies to all members of your family unit. All rights to benefits cease on date of termination. You will not be allowed to convert to non-group coverage or to re-enroll in Kaiser Permanente. You must pay non-member rates for any services received after the termination date. You have the right to appeal such a termination by contacting our Customer Service Department or the Colorado Division of Insurance.