SECTION 260:50-3-26. Termination of benefits

(a)   Termination of coverage. The coverage under this plan will terminate at the earliest time stated below:

(1)   On the last day of the calendar month in which employment terminates.

(2)   When the plan is discontinued.

(3)   When any required premiums cease to be paid.

(4)   The individual does not begin or continue coverage as an eligible participating former employee and/or dependent.

(5)   For a dependent when said dependent becomes ineligible for coverage.

(6)   A participating entity ceases to participate in this plan.

(b)   Representation of eligibility. Individuals who enroll a family member in the plan are representing that the individual is eligible under the terms of the plan and must provide evidence of eligibility upon request. The plan relies upon the member's representation of eligibility in accepting the enrollment of the family member, and the intentional provision of false evidence or the failure to provide required evidence of eligibility is evidence of fraud and material misrepresentation. The intentional provision of false evidence or the failure to provide evidence of eligibility will result in disenrollment of the individual, which may be retroactive to the date as of which the individual became ineligible for plan coverage, as determined by the plan.

(c)   Rescission of coverage obtained through false information. If material facts are submitted as a result of fraud, substantive error, inaccuracy, omission, misrepresentation, or any illegal or unauthorized activity, on any form or application for insurance coverage by or on behalf of a member or dependent, the coverage will be rescinded retroactively to the effective date. Written notice shall be sent by first class mail by EGID to the member's last known address of record no less than thirty [30] days prior to retroactive rescission of coverage. EGID reserves the right to recover the costs of any and all claims paid through such falsely obtained coverage from the ineligible member and/or dependent through all available means, at the discretion of EGID.

(d)   Dependent termination of coverage. In addition to (a), (b), (c) and (e) of this section, the coverage terminates with respect to an individual dependent on the last day of the calendar month in which such person ceases to be an eligible dependent.

(e)   Unlimited contestability period. There shall be no time limitation imposed upon EGID during which coverage based on materially false information submitted to EGID can be rescinded, if it is found that information as listed above in paragraph (c) was provided in order to obtain coverage, and that such information was material to EGID providing such coverage.

[Source: Added at 37 Ok Reg 1334, eff 9-11-20]