Aetna may terminate, cancel, or not renew the Group Service Agreement for the following reasons: In the event that Aetna does not receive premium payment from the employer group within 30
days of the payment due date. Aetna shall give 10 days written notice to the employer and 15 days written notice to subscribers prior to exercising this right of termination.
For an act or practice that constitutes fraud or makes intentional misrepresentation of material fact on the part of the employer group.
In the event that the employer group fails to comply with Aetna’s minimum employer contribution requirement. Aetna shall give 30 days written notice to the employer prior to exercising this right of termination.
In the event that the employer group fails to comply with Aetna’s minimum participation rate. Aetna shall give 30 days written notice to the employer prior to exercising this right of termination.
Aetna withdraws from the market in which the Group Service Agreement is sold, in accordance with applicable law. If coverage is terminated for this reason, Aetna shall give 180 days written notice to the employer group and subscribers.
No members live, reside or work in the Aetna Wyoming Service Area.
The employer group’s membership in an association, through which the health insurance coverage was made available, ceases.
It is the employer’s responsibility to provide immediate written notice of not less than 30 days to subscribers when the Group Service Agreement terminates, unless termination occurs according to Provisions 1 or 5 above. Notice given to a subscriber will be sufficient notice to all members enrolled as dependents of that subscriber.
The employer group may terminate the Group Service Agreement upon 30 days prior written notice to Aetna. Any such termination will be effective as of the latter of the last day of the month for which premiums have been paid, or 30 days after written notice has been provided to Aetna.
Termination of Member Coverage
otherwise specified in the Group Service Agreement, coverage shall remain in effect through the end of the month in which the terminating event occurs. Termination of a member’s coverage may occur in any of the following situations:
1. The loss of eligibility as a dependent of the subscriber. A subscriber’s spouse shall become ineligible upon the termination of marriage. A subscriber’s child shall become ineligible upon attainment of age 26 as specified in the Agreement, or as otherwise specified herein. Coverage shall remain in effect through the end of the month in which eligibility ends. If Aetna is not notified of the loss of eligibility within 31 days after such loss occurs, Aetna at its option may choose to terminate coverage at the end of the month in which Aetna becomes aware that a child or former spouse is no longer an eligible dependent.
2. The subscriber chooses to terminate membership in the Aetna plan during the open enrollment period.
3. The subscriber terminates employment with the employer group or no longer meets the employer group’s eligibility requirements.
4. The death of the subscriber. All rights to benefits and services through Aetna cease as of the date of death.
5. The employer’s group plan is terminated.
6. Upon 30 days notice from Aetna if a member fails to live, work, or reside in the Aetna Service Area as defined herein. If a member is terminated for this reason, all rights cease as of the coverage termination date.
If a subscriber requests termination of a spouse’s coverage for any reason other than divorce or annulment, Aetna may require verification of the spouse’s consent for such termination.
Termination For Cause
Aetna may rescind your coverage if you, or the person seeking coverage on your behalf: • Performs an act, practice or omission that constitutes fraud; or
• Makes an intentional misrepresentation of material fact
on a written enrollment form or application signed by the Member and a copy of that enrollment form or application has been furnished to the Member or Member’s personal representative. The
misrepresentation or fraud may not be related to health status.
You will be given 30 days advance written notice of any rescission of coverage.
You have the right to an internal Appeal with Aetna and/or the right to a third party review conducted by an independent External Review Organization if your coverage under this Certificate is rescinded retroactive to its Effective Date.
Coverage will not be terminated on the basis of a Member’s health status or health care needs, nor if a Member has exercised the Member’s rights under the Certificate’s Complaints and Appeals, External Review, and Dispute Resolution sections to register a Complaint with Aetna.
A Member may register a Complaint with Aetna as described in the Complaints and Appeals, External Review and Dispute Resolution sections of the Certificate, after receiving notice that Aetna has or will terminate the Member’s coverage as described in the Termination For Cause subsection of the
Certificate. Aetna will continue the Member’s coverage in force until a final decision on the
Complaint is rendered, provided the Premium is paid throughout the period prior to the issuance of that final decision. Aetna may rescind coverage, to the date coverage would have terminated had the Member not registered a Complaint with Aetna if the final decision is in favor of Aetna. If coverage is rescinded, Aetna will provide the Member with a 30 day advance written notice prior to the date of the rescission, and refund any Premiums paid for any period after the termination date, minus the cost of Covered Benefits provided to a Member during this period.
Coverage will not be terminated on the basis of a Member’s health status or health care needs, nor if a Member has exercised the Member’s rights under the Certificate’s Complaints and Appeals, External Review, and Dispute Resolution sections to register a Complaint with Aetna. The Complaint process described in the preceding paragraph applies only to those terminations affected pursuant to the
Aetna shall have no liability or responsibility under this Certificate for services provided on or after the date of termination of coverage.
The fact that Members are not notified by the Contract Holder employer of the termination of their coverage due to the termination of the Group Agreement shall not continue the Members' coverage beyond the date coverage terminates.