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When Coverage Terminates
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Your health plan coverage will be terminated for any of the following reasons:
- The entire policy is terminated with the employer group;
- Your residence and employment are no longer in PHPSM’s service area;
- You are no longer eligible according to the employer group contract;
- The monthly fee for benefits is not paid on time, subject to a 30-day grace period. The coverage will terminate effective on the last date for which payment by your employer, or in the case of individual coverage, by you, was received;
- You fail to pay required copays;
- You knowingly gave PHPSM false information at the time of enrollment, or breach any term of condition of your subscriber contract.
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Option to Continue Group Coverage
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You may have the right to continue your group coverage, even after it would otherwise terminate. This option also applies to your spouse and any children covered under the plan. This option is provided under Federal Law, specifically the Consolidated Omnibus Budget Reconciliation Act (COBRA).
If you are eligible for this option and choose it, you must make regular monthly payments. You will be charged the full cost of coverage, plus an added amount to help cover the group’s administrative costs. For full details, please consult your personnel office or human resource department.
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Electing Conversion Coverage
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If your group coverage ends and COBRA is not available or COBRA coverage ends, you may be eligible for conversion coverage through PHPSM if you reside within the service area. Application and payment for conversion coverage must be made within 31 days of termination from PHPSM.
Your plan will become effective the date your coverage ends under your group plan. If you choose this option, you will receive the benefit plan that is the PHPSM standard at the time of conversion. For information about the benefits and premium costs, please contact our Customer Service Department.
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