Hassle-Free Health Coverage: Enrollment
Your HMO must provide you with evidence of coverage within 60 days of enrollment.
Evidence of coverage is equivalent to a Certificate of Insurance for standard insurance policies.
The evidence of coverage should include your coverages and benefits (including your required co-payments), benefit limits, exclusions, and specified conversion privileges. It should also include:
- the name, address, and telephone number of the HMO;
- the effective date and term of coverage;
- a list of providers and a description of the service area;
- terms and conditions for termination;
- a complaint system;
- a 31-day grace period for premium payment provision;
- a coordination of benefits provision;
- incontestability clause; and
- a provision on eligibility requirements for membership in the HMO.
Other provisions may also be found in the evidence of coverage; but those listed above must be included.
