Termination of Insurance Employees Your insurance will cease on the earliest date below: • last day of the calendar month in which you cease to be in a Class of Eligible Employees or cease to qualify for the insurance. • the last day of the calendar month in which you have made any required contribution for the insurance. • the date the policy is cancelled. • the last day of the calendar month in which your Active Service ends except as described below. Any continuation of insurance must be based on a plan which precludes individual selection. Temporary Layoff or Leave of Absence If your Active Service ends due to temporary layoff or leave of absence, your insurance will be continued until the date as determined by your Employer. Injury or Sickness If your Active Service ends due to an Injury or Sickness, your insurance will be continued while you remain totally and continuously disabled as a result of the Injury or Sickness. However, your insurance will not continue past the date your Employer cancels your insurance. Dependents Your insurance for all of your Dependents will cease on the earliest date below: • the date your insurance ceases. • the date you cease to be eligible for Dependent Insurance. • the last day of the calendar month for which you have made
individual) performs an act, practice or omission that constitutes fraud; or the plan sponsor or individual (or a person seeking coverage on behalf of the individual) makes an intentional misrepresentation of material fact.
HC-TRM80
01-11
Federal Requirements The following pages explain your rights and responsibilities under federal laws and regulations. Some states may have similar requirements. If a similar provision appears elsewhere in this booklet, the provision which provides the better benefit will apply.
HC-FED1
10-10
Notice of Provider Directory/Networks Notice Regarding Provider Directories and Provider Networks A list of network providers is available to you without charge by visiting the website or by calling the phone number on your ID card. The network consists of providers, including hospitals, of varied specialties as well as general practice, affiliated or contracted with Cigna or an organization contracting on its behalf. Notice Regarding Pharmacy Directories and Pharmacy Networks A list of network pharmacies is available to you without charge by visiting the website or by calling the phone number on your ID card. The network consists of pharmacies affiliated or contracted with Cigna or an organization contracting on its behalf.
any required contribution for the insurance. • the date Dependent Insurance is cancelled.
The insurance for any one of your Dependents will cease on the last day of the calendar month of which the date that Dependent no longer qualifies as a Dependent.
HC-FED78
10-10
Qualified Medical Child Support Order (QMCSO) Eligibility for Coverage Under a QMCSO If a Qualified Medical Child Support Order (QMCSO) is issued for your child, that child will be eligible for coverage as required by the order and you will not be considered a Late Entrant for Dependent Insurance.
HC-TRM128 M
12-17
Rescissions Your coverage may not be rescinded (retroactively terminated) by Cigna or the plan sponsor unless the plan sponsor or an individual (or a person seeking coverage on behalf of the
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