TAKEOVER PROVISION
This provision applies only to Employees and the Employee's dependents who were covered for Hospital Indemnity coverage under a Prior Plan provided by the Subscriber or by an entity that has been acquired by the Subscriber on the day prior to the date the Employee would have first become eligible to be insured under this Policy. 1. This section A applies to Employees who are not in Active Service on the day prior to the date the Employee would have first become eligible to be insured under this Policy due to a reason for which the Prior Plan and this Policy both provide for continuation of coverage. If the required premium is paid when due, We will insure an Employee and the Employee's dependents, to which this section applies during and for the balance of the period for which coverage would be continued under the Prior Plan that occurs after the effective date of this Policy. This coverage will be provided until the earlier of the date: (a) the Employee returns to Active Service, or (b) continuation of coverage under the Prior Plan would end but for termination of that plan. The Policy will provide this coverage as follows: 1. If benefits are payable under the Prior Plan during the period that coverage is continued, then no benefits are payable under this Plan. 2. If benefits are not payable under the Prior Plan during the period that coverage is continued, solely because the Prior Plan terminated, benefits payable under this Policy will be the lesser of: (a) the benefits that would have been payable under the Prior Plan; or (b) those provided by this Policy. Credit will be given for partial completion under the Prior Plan of Elimination Periods. 2. For any benefit offered with this Policy that is subject to an Elimination Period, the Elimination Period under this Policy, if applicable, will be waived while the Employee, and the Employee's dependents, are insured under this Policy if all of the following conditions are met: 1. The Covered Loss results from the same or related causes as a Covered Loss for which benefits were payable under the Prior Plan; 2. Benefits are not payable for the Covered Loss under the Prior Plan solely because it is not in effect; 3. A Elimination Period would not apply to the Covered Loss if the Prior Plan had not ended; 4. The Covered Loss begins within 90 days of the Employee’s return to Active Service and the Employee’s and the Employee’s dependents coverage under this Policy is continuous from this Policy's Effective Date. For purposes of paragraph B, benefits will be determined based on the lesser of: (1) the amount of the gross benefit under the Prior Plan and any applicable maximums; and (2) those provided by this Policy, including Optional Benefits. If benefits are payable under the Prior Plan for a Covered Loss confinement, then no benefits are payable under this Policy.
TERMINATION OF INSURANCE
Coverage on a Covered Person will end on the earliest date below: 2.
the date this Policy or coverage for a Covered Class is terminated; 3. the date the Employee is no longer in Active Service; 4. for a Spouse, the date the Spouse reaches age 100; 5. for a Dependent Child, the date the Dependent Child reaches age 26, unless primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap; 6. the date the Employee is no longer in a Covered Class or satisfies eligibility requirements under this Policy; 7. the last day for which premium is paid; 8. with respect to a Spouse or Dependent Child, the date of the death of the covered Employee or the date of divorce from the covered Employee, unless the Spouse elects to continue coverage, including coverage on any Dependent Child. 9. the date that the plan of benefits under which the Covered Person is covered is terminated.
Termination will not affect a claim for a Covered Loss that is the result, directly and independently of all other causes, of a Covered Injury or Covered Illness that occurs while coverage was in effect.
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