25C - AGMT GROUP INSURANCE - Laserfiche WebLink

Home Browse Search

5. The Individual first obtains coverage for dental benefits, after the date of the election of continued coverage, under another group health plan (as an employee. or dependent) which does not contain or apply any exclusion or limitation with respect to any pre-existing condition of such person, if that pre-existing condition is covered under this plan; Entitlement to Medicare. The employer or Primary Enrollee shall notify Delta Dental or the administrator within 30 days of the occurrence of any of the above events. Once continued coverage terminates, It cannot be reinstated. 10.8 TERMINATION OF THE EMPLOYER'S DENTAL CONTRACT If the dental contract between the employer and Delta Dental terminates prior to the time that the continuation coverage would otherwise terminate, the employer shall notify a Qualified Beneficiary (either 30 days prior to the termination or when all Enrollees are notified whichever Is later) of that person's ability to elect continuation coverage under the employer's subsequent dental plan, If any. The employer must notify the successor plan of the Qualified Beneficiaries receiving continuation coverage so they may be notified of how to continue coverage under that plan. The continuation coverage will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the Delta Dental plan had such plan with the former employer not terminated. The continuation coverage will terminate if a Qualified Beneficiary falls to comply with the requirements pertaining to enrollment In, and payment of Premium to the new group benefit plan within 30 days of receiving notice of the termination of the Delta Dental plan. 10.9 OPEN ENROLLMENT CHANGE OF COVERAGE A Qualified Beneficiary may elect to change continuation coverage during any subsequent open enrollment period, if the employer has contracted withanother plan to provide coverage to Its active employees. The continuation coverage under the other plan will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the Delta Dental plan. ARTICLE 11 - GENERAL PROVISIONS 11.1 No agent has authority to change this Contract or waive any of Its provisions. Delta Dental may not change Premium rates, copayments or deductibles, If any, during any of the following time periods: (a) after the Contractholder has delivered written acceptance of the Contract, (b) after the start of an annual open enrollment period, and; (c) after receipt of the Premium for the first month of the contract term. Premiums may be changed under the following exceptions: (a) when authorized or required In the Contract, (b) when Premiums are subject to execution of a definitive agreement, and; (c) when Delta Dental and the Contractholder mutually agree in writing. No change in this Contract is valid unless.approved by an executive officer of Delta Dental and Included In this Contract by written amendment. zo 25C-72