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Insurance Type:

Kids and Health Care: 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 copayments), 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 be found in the evidence of coverage, but those listed above must be included.

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