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2. the date You are given notice of a right to continue coverage; and 3. the date coverage under this plan ends. When You or Your dependents become entitled to continue benefits under the plan because of: 1, Your or Your dependent's receipt of determination of disability under the terms of the Social Security Act; 2. Your dependent child's ceasing to qualify as a dependent under this plan; 3. Your divorce; 4. Your legal separation; 5. Your death; or 6. Your becoming eligible for Medicare; You or Your dependent must notify us within sixty (60) days. If We do not receive notice within sixty (60) days, the person or persons who would otherwise have been entitled to continued benefits will be disqualified from having dental benefits continued. You or Your dependent's notice and request for continued benefits must be in Writing and delivered to Us by first class mail or other reliable means of delivery including personal delivery, express mail, or private courier company. Cost of Continued Coverage Any person who elects to continue coverage under the plan must pay not more than one -hundred and ten percent (110%) of the full cost of that benefits (including both the share You now pay and the share Your Organization now pays), Payment of the Prepayment Fees The first Prepayment Fee must be paid within forty-five (45) days of Your election to continue benefits. Your first payment of the Prepayment Fee must be sufficient to pay all required Prepayment Fees and all Prepayment Fees due. The Prepayment Fee payment must be sent to Us by first class mail, certified mail or other reliable means of delivery, including personal delivery, express mail or private courier company. After the first Prepayment Fee payment, Your payments for continued coverage must be made on the first day of each month in advance. Failure to submit the correct Prepayment Fee amount within the forty-five (45) day period will disqualify the person(s) to whom the Prepayment Fee relates from receiving continuation coverage. Exceptions This right to continue coverage under this plan does not apply: 1. to a person who is not a resident of California; 2. to a person who is covered by or eligible to be covered by Medicare; 3. to a person who is covered or who becomes covered by another group benefit plan that does not have an exclusion or limitation for preexisting conditions that applies to the person; 4. to a person who is covered, becomes covered, or could become covered by Federal Cobra (Section 4980B of the United States Internal Revenue Code); 5. to a person who is covered, becomes covered, or could become covered under a plan governed by Chapter 6A of the Public Health Service Act, 42 U.S.C. Section 300bb-1 et seq., relating to Requirements for Certain Group Health Plans for Certain State and Local Employees; 6. to a person who fails to meet any one or more of the time limits set forth above for notice and election of coverage; 7, to a person who fails to submit the correct Prepayment Fee when or before it is due; 8. if at the time coverage under this plan ends Your Organization has twenty (20) or more employees; or 9. if Your Organization fails to notify Us of Your termination or reduction In hours within thirty-one (31) days. GCERT2011-DHMO-EOC 25C-31 17