When Georgia Health Insurance Coverage Terminates

Termination of Coverage (Group)

BCBSHP may cancel this Plan on the renewal date in the event of any of the following:
1. The Group fails to pay Premiums in accordance with the terms of this Plan.
2. The Group performs an act or practice that constitutes fraud or intentional misrepresentation of material fact in applying for or procuring coverage.
3. The Group has fallen below BCBSHP's minimum Employer contribution or group participation rules.
4. BCBSHP terminates, cancels or non-renews all coverage under a particular policy form, provided that:

• BCBSHP provides at least 90 days notice of the termination of the policy form to all Participants;
• BCBSHP offers the Group all other small group (Employer) or large group (Employer) policies, depending on the size of the Group, currently being offered or renewed by BCBSHP for which it is otherwise eligible; and
• BCBSHP acts uniformly without regard to the claims experience or any health status related factor of the individuals insured or eligible to be insured.

Extension of Benefits in Case of Total Disability

If the Group Plan is terminated for non-payment of subscription charges, or if the Group terminates the Plan for any reason; or if the Plan is terminated by BCBSHP (with 60 days written notice), then in such event the coverage of a totally disabled Subscriber will be as follows: Plan benefits for the care and treatment of the specific illness, disease or condition that caused the total disability will be extended up to twelve (12) months from the date of termination of the Group Plan or to the maximum of the amount payable under this Plan during the extension period.

NOTE: BCBSGA considers total disability a condition resulting from disease or Injury where:

• the Member is not able to perform the major duties of his or her occupation and is not able to work for wages or profit; or
• the Member's Dependent is not able to engage in most of the normal activities of a person of the same age and sex.

Extended Benefits

If a Member's coverage ends and he or she is totally disabled, under a Physician's care, and not covered by another plan of group benefits, BCBSHP extends major medical benefits for that Member under this Plan as explained below. This is done at no cost to the Member.

BCBSHP only extends benefits for Eligible Charges due to the disabling condition. The Eligible Charges must be incurred before the extension ends. What BCBSHP pays is based on all the terms of this Plan.

BCBSHP does not pay for charges due to other conditions. BCBSHP does not pay for charges incurred by other covered Dependents.

The extension ends on the earliest of: (a) the date the total disability ends, or (b) one year from the date the Member's coverage under this Plan ends. It also ends if the Member has reached the payment limit for his or her disabling condition.

NOTE: BCBSHP considers total disability a condition resulting from disease or Injury where the Member is not able to perform the major duties of his or her occupation and is not able to work for wages or profit.

Enhanced Conversion Rights

You and/or your Dependents may be a "qualifying eligible individual" for an enhanced conversion product if:

• your most recent coverage was under a group plan or continuation coverage;
• coverage under this Plan has been terminated for any reason other than fraud or failure to pay a required Premium;
• all continuation (COBRA) coverage has been exhausted;
• there is 18 months of prior Creditable Coverage immediately prior to termination;
• you are not eligible for, nor have declined, any of the following:
• 1. Any group health policy (including continuation under COBRA or state continuation);
  2. Medicare;
  3. Medicaid or a similar program;
• you are not covered under any other creditable health insurance coverage, including individual or student health coverage.

You must file a substantially completed application for such enhanced conversion coverage, and pay the first Premium, no later than 63 consecutive days after a qualifying event, or the date of notice of enhanced conversion rights, whichever is later.

If you do not qualify for enhanced conversion rights, you may qualify for standard conversion rights as set out below.

Continuation of Coverage (Federal Law-COBRA)

If your coverage ends under the plan, you may be entitled to elect continuation coverage in accordance with federal law. If your Employer normally employs 20 or more people, and your employment is terminated for any reason other than gross misconduct, instead of the three months continuation benefit described above, you may elect from 18-36 months of continuation benefits, regardless of whether the Group is insured or self-funded.

Qualifying events for Continuation Coverage under Federal Law (COBRA)

COBRA continuation coverage is available when your group coverage would otherwise end because of certain "qualifying events." After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." You, your Spouse and your dependent children could become qualified beneficiaries if covered on the day before the qualifying event and group coverage would be lost because of the qualifying event. Qualified beneficiaries who elect COBRA must pay for this COBRA continuation coverage.

This benefit entitles each member of your family who is enrolled in the company's employee welfare benefit plan to elect continuation independently. Each qualified beneficiary has the right to make independent benefit elections at the time of annual enrollment. Covered Employees may elect COBRA continuation coverage on behalf of their Spouses, and parents or legal guardians may elect COBRA continuation coverage on behalf of their children. A child born to, or placed for adoption with, a covered Employee during the period of continuation coverage is also eligible for election of continuation coverage.