Res 1988-077 - Laserfiche WebLink

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termination was not based upon non-payment I)f premium or copayment, fraud, an untenable relationship (see Section X), misuse of ID card, or misrepresentation. An Enrollee or Family Dependent shall be entitled to have issued to him/her without evidence cf gcod health, an Individual Conversicn Contract. The Individual Conversion Contract may be obtained by making written applicaticn and paying the required Health Services Fee to Health Plan within thirty-one (31) days after termination cf coverage under this Contract, the effective date of coverage under the Individual Conversion Contt~act being the FÜ~st day aftet~ the ter~mination \)f cIJver~age undet~ this C':lntr'act. Health Plan or the Enrolling Unit, upon request, will furnish to an Enrollee all the details of the Individual Conversion Contract available. Out-of-Service Area Conversion Privileges In the event coverage under' this C')ntt~act terminates due t,:, the prclvisilJns described under In-Service Area Conversion Privilege, and in the event terminating Covered Person(s) leave the service area as described in Section I (Service Area) of this Contract, such Covered Person(s) shall be eligible, if application is made within thirty-cne (31) days of termination, for an individual insurance plan. Contact the Health Plan f,)r information concerning the current insl.lr~ance car~rier. SECTION X PREVENTION OF MEDICALLY HARMFUL USE OF SERVICES AND LIMITATIONS ON COVERAGE RELATED THERETO If tWIJ (2) or more Participating Physicians who have rendered care to a Covered Person infor'm Health Plan that the Covered Person is receiving Health Services or Prescription Medications in a manner or in a quantity which is not Medically Necessary or not medically beneficial, the Covered Person may be required by Health Plán to select a single Participating Physician (her'eafter' referred tQ as a "Col)r~dinat ing Health Plan Physician") and a single Participating Pharmacy for the provision and coordination of all future Health Services. If the Covered Person fails to voluntarily select a Coordinating Health Plan Physician and a single Participating Pharmacy within thirty (3Ø) days of written notice by Health 'Plan of the need to do so, Health Plan shall designate a C,)I;:.rdinating Health Plan Physician and a Par'ticipating Phar'macy fQr' that Covered Person. Following selection or designation Qf a Coordinating Health Plan Physician f,)r a C,)vered Person, coverage fot~ Health Services set f,)rth in Section XI I)f the Contract and the Schedule IJf Benefits shall be contingent upon theÜ' being prlJvided by or thrlJugh written referral of the ColJrdinating Health Plan Physician for that C'Jvered Per's.:,". If after sixty (60) days from initial notification by Health Plan, the Covered Person is not in compliance with Section X, the coverage may be terminated by Health Plan. GM-12-19