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Atlantis Outpatient Centers


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Right to Continuation of Coverage

1. EXTENSION OF BENEFITS

Benefits for a Member may be extended if on the date coverage under this Contract terminates:

(a) The Member is receiving inpatient care in a hospital or skilled nursing facility on the date of termination of coverage under the Contract. In such case, the Member is covered until one of the following events is met: (a) discharge from inpatient care, (b) inpatient care is determined by the attending physician to be no longer Medically Necessary, or (c) 90 days from termination of coverage.

(b) The Member is totally disabled on the date the Agreement is terminated. Coverage will be extended for services and treatment for the particular injury or illness that is the cause of the total disability. Benefits will continue for such disabling condition for 12 months from the date extended benefits began or until the total disability ceases, whichever occurs first. The disability must be continuous and the Member must either be unable to perform any occupation or daily living activities.

2. CONVERSION TO AN INDIVIDUAL DIRECT PAYMENT CONTRACT

A Member may have the option to convert to individual coverage with the Plan, on a direct payment basis, when group eligibility ends for any of the following reasons:

(a) The group coverage was terminated and not replaced with similar and continuous coverage for the same group whether insured or self-insured by the remitting agent.

(b) The Subscriber ceased to meet the eligibility requirements under the Contract.

(c) A Dependent ceased to meet the eligibility requirements due to age or the death or divorce of the Subscriber.

(d) A spouse is no longer covered under the Contract because of divorce from the Subscriber or annulment of the marriage.

(e) The Subscribers' coverage under the group plan ends due to termination of employment, a reduction in work hours, or membership in the class or classes eligible for coverage under the contract.

Such individual, former spouse, surviving spouse or other dependents of the Subscriber may convert to an individual direct payment contract if itsí issuance would not result in overinsurance or duplication of benefits according to standards on file with the Superintendent and approved by him with regards to such contracts.

The Member may convert to individual Membership in the Plan within forty-five (45) days after the termination of the Contract, The Member may exercise this right by completing an application for conversion without furnishing evidence of insurability and making the first payment. The effective date for the conversion contract shall be the day following the

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