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2. the date You are given notice of a right to continue coverage; and <br />S. the date coverage under this plan ends. <br />When You or Your dependents become entitled to continue benefits under the plan because of. <br />1, Your or Your dependent's receipt of determination of disability under the terms of the Social Security Act; <br />2. Your dependent child's ceasing to qualify as a dependent under this plan; <br />3. Your divorce; <br />4. Your legal separation; <br />5. Your death; or <br />6. Your becoming eligible for Medicare; <br />You or Your dependent must notify us within sixty (60) days. If We do not receive notice within sixty (60) <br />days, the person or persons who would otherwise have been entitled to continued benefits will be disqualified <br />from having dental benefits continued. You or Your dependent's notice and request for continued benefits <br />must be in Writing and delivered to Us by first class mail or other reliable means of delivery including personal <br />delivery, express mall, or private courier company. <br />Cost of Continued Coverage <br />Any person who elects to continue coverage under the plan must pay not more than one -hundred and ten <br />percent (110°/x) of the full cost of that benefits (including both the share You now pay and the share Your <br />Organization now pays). <br />Payment of the Prepayment pees <br />The first Prepayment Fee must be paid within forty-five (45) days of Your election to continue benefits. Your <br />first payment of the Prepayment Fee must be sufficient to pay all required Prepayment Fees and all <br />Prepayment Fees due. The Prepayment Fee payment must be sent to Us by first class mail, certified mail or <br />other reliable means of delivery, including personal delivery, express mail or private courier company. After <br />the first Prepayment Fee payment, Your payments for continued coverage must be made on the first day of <br />each month in advance. Failure to submit the correct Prepayment Fee amount within the forty-five (45) day <br />period will disqualify the person(s) to whom the Prepayment Fee relates from receiving continuation <br />coverage. <br />Exceptions <br />This right to continue coverage under this plan does not apply: <br />1. to a person who Is not a resident of California; <br />2, to a person who is covered by or eligible to be covered by Medicare; <br />3. to a person who is covered or who becomes covered by another group benefit plan that does not have an <br />exclusion or limitation for preexisting conditions that applies to the person; <br />4. to a person who is covered, becomes covered, or could become covered by Federal Cobra (Section <br />49608 of the United States Internal Revenue Code); <br />5. to a person who is covered, becomes covered, or could become covered under a plan governed by <br />Chapter 6A of the Public Health Service Act, 42 U.S.C. Section 300bb-1 et seq., relating to Requirements <br />for Certain Group Health Plans for Certain State and Local Employees; <br />6. to a person who fails to meet any one or more of the time limits set forth above for notice and election of <br />coverage; <br />7. to a person who fails to submit the correct Prepayment Fee when or before it is due; <br />8. if at the time coverage under this plan ends Your Organization has twenty (20) or more employees; or <br />9. if Your Organization fails to notify Us of Your termination or reduction in hours within thirty-one (31) days. <br />GCERT2011-DHMO-EOC 250-31 t7 <br />