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Eligibility, Coverage and Payments
Eligibility | Coverage | Payment
and the Waiting List | Termination
of Coverage | Impartial
Eligibility Review
Termination of Coverage
The Caring Foundation may cancel your adultBasic coverage
under the following conditions:
- If you commit willful misrepresentation or fraud in
applying for or obtaining coverage for you or a family
member from the Caring Foundation (subject to your rights
under the member complaint and grievance process);
- If you misuse your ID card, or allow someone other
than yourself to use the ID Card to receive care or
benefits;
- If you cease to meet eligibility requirements;
- If you cease to meet eligibility requirements;
- If you fail to respond to the renewal request or return
incomplete information with the renewal (more
information); or
- If you fail to pay your Low Cost or At Cost premium
by the due date.
Inpatient Provision
If you are receiving inpatient care in a hospital or skilled
nursing facility on the day adultBasic coverage is terminated,
except for termination due to fraud or material misrepresentation,
the benefits shall be provided until the earliest of:
- The expiration date of such benefits according to the limitations included within this handbook;
- Determination of the primary care physician and Keystone that inpatient care is no longer medically necessary; or
- Your discharge from the facility.
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| NOTE: |
The Caring
Foundation will not terminate your coverage
because of your health status or need for
medically necessary covered services, or because
you exercised your rights under the complaint
and grievance process. |
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