Termination of Group Coverage
The Group Health Care Coverage may be terminated if one or more of the conditions discussed in this section occurs.
For fully-insured groups, premium payments are due on the first day of the month of the coverage period. A 31-day grace period beyond the first of the month is given for payment to be received.
A group that fails to remit the full premium prior to the expiration of the applicable grace period will be terminated as of the end of the grace period. The group will be responsible for payment of the grace period premium, in addition to any premiums already owed, even if no claims were incurred. All claims incurred after the expiration of the grace period will be denied.
Employees of the group coverage will have 31 days from the date of cancellation notice to apply and pay for coverage under the conversion option. Conversion materials will not be sent unless requested. Payment procedures for self-insured groups can be found in the master Group Contract.
A group that applies for coverage within 12 months of cancellation for non-payment of premiums or returned checks must comply with any credit and collection policies in place before re-enrolling. These may include payment of any previously unpaid grace period premiums and advance payment of multiple months of premium.
A group will have failed to make timely payment of its monthly premium if the group's monthly premium check is returned for insufficient funds, closure of an account, an unauthorized signature, or any other reason.
If the group fails to make timely payment of its monthly premium twice within a 12-month period, its coverage will be canceled.
Cancellation will also occur if a returned check places the group's paid-to-date outside the statutory 31-day grace period.
Minimum Enrollment Requirements Not Maintained
A group whose enrollment falls below the minimum participation requirement will be terminated. Anthem will advise the group in writing and specify the date of termination.
Employees leaving the group for this reason will be eligible for conversion to individual policies if application is made within 31 days of becoming ineligible for group coverage. All standard operating policies pertaining to the Non-Group Coverage will be applicable.
Employer Goes Out of Business
A group whose originating organization goes out of business will have its group coverage terminated as of the paid-to date.
Employees leaving a group for this reason will be eligible for conversion to individual policies if application is made within 31 days of becoming ineligible for group coverage. All standard operating policies pertaining to individual coverage will be applicable.
Employer Requests Termination
An employer can request termination of its group policy on the last day of any month by submitting the request in writing 30 days before the effective date of termination and identifying whether the group has obtained other coverage.
Failure to notify Anthem Blue Cross and Blue Shield in writing in accordance with the contract will result in the group being liable for premiums covering the 31-day grace period, even if other coverage has been obtained.
This applies to cancellation of the group policy on or off the renewal date.