Membership

Remember, when you add or remove Dependents, your type of membership (individual, two-person, or family) may change.

You may add or remove Dependents from your membership anytime. To request membership changes, call (888) 445-5805. Please call this number if:

• your name changes due to marriage or divorce;
• your address changes; or
• you become eligible for Medicare.

Note: If you receive premium assistance and need to make a change to your type of membership, contact the Office of Vermont Health Access at 1-800-250-8427.

Membership Eligibility Criteria
You and your Dependents are eligible for coverage under this health plan if you are Uninsured as defined in Chapter Nine. You are not eligible for this coverage if:

• you are eligible for coverage through your employer or other group health plan, unless the Office of Vermont Health Access determines you are eligible for Catamount Health;
• you are eligible for coverage through your spouse's  employer or other group health plan, unless otherwise allowed by law;
• you are eligible for Medicare or other government sponsored program, unless otherwise required or allowed by law; or
• you are not a Vermont resident or you are claimed as a dependent on a tax return by a person who is not a Vermont resident.

Adding Dependents
You may add a Dependent when any of the following events occurs:

Marriage/Civil Union
If we receive your application within 31 days after the date of marriage/Civil Union, your new type of membership is effective the first day of the month following the date of marriage/Civil Union. If we receive your request more than 31 days after the date of your marriage/Civil Union, your new membership becomes effective the first day of the month after we receive your request.

Birth or Adoption
If you already have a family membership, we cover your new Child from the date of birth, legal placement for adoption or legal adoption. You should, however, notify us of your family addition within 31 days.
If you do not have a family membership, we cover your Child for 31 days after:

• birth;
• legal placement for adoption (when placement occurs prior to adoption finalization); or
• legal adoption (when placement occurs at the same time as adoption finalization).

However, we must receive your application for a membership change in order to continue benefits for the Child past 31 days. If we receive your request within the 31 days:

• the Child's effective date is retroactive to the date of birth, placement for adoption or adoption; and
• the new type of membership is effective the first day of the month following birth, placement for adoption or adoption.

If we receive your request within 32 to 60 days, the Child's membership and the new type of membership are effective the first day of the month following our receipt of your request.

Note:
Dependents who do not become Covered within 94 days must fulfill their own waiting periods for Pre-existing Conditions.

Dependent's Loss of Coverage
Any Dependents Covered under health coverage with another health plan are eligible for membership under your Contract if the Dependent loses his or her group health coverage or terminates employment.  You should notify us as soon as possible after a Dependent loses coverage, preferably within 31 days. Dependents who are uninsured for more than 94 days may have to fulfill their own waiting periods for Pre-existing Conditions.

Court-ordered Dependents
The effective date of a court-ordered addition of a Dependent is the first of the month after we receive your request unless otherwise required by law. The request must include proof of the court order.

Over-age Dependents

Dependent Students
You may include unmarried, full-time students (taking 12 credits or more per semester or on a Medically Necessary leave of absence from the college) between the ages of 19 and 25 as Dependents on your membership (unless you receive premium assistance; if so, please contact the Office of Vermont Health Access at 1-800-250-8427). To include a  Dependent student on your membership, you must provide us with the following information:

• written notice of your Child's student status on our Student Certification form; and
• written proof (acceptable to us) of student status.
  

If a Child is a full-time student on his or her 19th birthday, he or she may continue on your membership without meeting new waiting periods for Pre-existing Conditions. To continue the membership, however, we must receive the request before the first of the month following the student's 19th birthday.

If your Child becomes a student after his or her 19th birthday, waiting periods may apply. If we receive your request for student status within 60 days after he or she becomes a student, the student's coverage is effective the first of the month following our receipt of your request.

Dependent student coverage ceases the first day of the month after a student:

• marries;
• is no longer a full-time student;
• no longer lives in the Subscriber's home; or
• turns 25 years of age.

Incapacitated  Dependents
In order to provide continued coverage for an Incapacitated Dependent, we must receive the following:

• an application form for Incapacitated Dependents (which you may obtain from our customer service department); and
• Physician certification of the extent and nature of the handicap.

Our medical director must review the above information and find the Dependent Incapacitated as defined by law before we will provide coverage.

If we receive the information later than 31 days prior to the date the individual would no longer be eligible, coverage will become effective the first day of the month after we receive the information. The Over-age Dependent may be subject to his or her own waiting periods for Pre-existing Conditions.

Removing Dependents
You must remove Dependents from membership with us if any of the following events occurs:

• a Dependent dies;
• the Subscriber and Spouse/Party to a Civil Union divorce (Spouse is removed);
• A child no longer meets the definition of a Child (marries, turns 19 or no longer lives in the Subscriber’s home as his or her permanent residence) and does not meet the definition of Over-age Dependent;
• an Incapacitated Dependent is no longer Incapacitated; or
• a student ceases to be a full-time student as described above and does not otherwise meet the definition of Over-age Dependent.

Dependents become ineligible for coverage under your Contract at the end of the month after the event occurs.

Termination of Coverage

Termination of Coverage by You or by Us

You may terminate this Contract without cause at the end of any calendar month by giving 15 days prior written notice.  BCBSVT may terminate this Contract in accordance with State and Federal law.

Upon Contract termination, we refund you the amount of any unearned prepaid subscription rates we hold. Such payment constitutes a full and final discharge of all our obligations under this Contract, unless otherwise required by law. We will continue to provide benefits for all Covered Services received before the date of termination.