If an Employee’s coverage ends due to Loss of Eligibility from a qualifying event as defined in this section, coverage will continue up to the Maximum Benefit Period as shown in the Schedule of Benefits . The qualifying event means: 1. loss of employment, including a reduction in hours that results in ineligibility for employer-sponsored coverage; 2. divorce, dissolution, or legal separation of the covered employee from the employee’s spouse or civil union partner; 3. a dependent child ceasing to qualify as a dependent child under the generally applicable requirements of the policy; or 4. death of the covered employee or member. The Provisions of this section will not apply if 1. the deceased person or Employee was not insured under the group policy on the date of the qualifying event; 2. the person is covered by Medicare; 3. the person is covered by any other group insured or uninsured arrangement which provides dental coverage or hospital and medical coverage for individuals in a group and under which the person was not covered immediately prior to such qualifying event, and no preexisting condition exclusion applies.
6) Remove Portability Provisions section entirely.
7) Under the Common Exclusions and Limitations section, remove the following exclusion:
• voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction a Physician and taken in accordance with the prescribed dosage; • Pregnancy, including childbirth, occurring within the first 9 months of the Covered Person’s effective date of coverage. This Exclusion does not apply to Complications of Pregnancy.
8) Under the Claims Provision section, the Physical Examination and Autopsy provision is replaced with the following:
We, at Our own expense, have the right and opportunity to examine the Covered Person when and as often as We may reasonably require while a claim is pending and to make an autopsy in case of death unless the law or the Covered Person’s religion forbids it.
9) Under the General Provisions section, the Incontestability provision is revised as follows:
This Policy or Participation Under This Policy All statements made by the Policyholder to obtain this Policy or to participate under this Policy are considered representations and not warranties. No statement will be used to deny or reduce benefits or be used as a defense to a claim, or to deny the validity of this Policy or of participation under this Policy unless a copy of the instrument containing the statement is, or has been, furnished to the Policyholder.
After three years from the Policy Effective Date, no such statement will cause this Policy to be contested except for fraud.
A Covered Person's Insurance
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