Part 12 – Individual Policy (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 109 Termination of Individual Coverage by Blue Cross Blue Shield HMO Blue Your coverage in this health plan under an individual contract will not be canceled because you are using your coverage or because you will need more covered services in the future. In the event that Blue Cross Blue Shield HMO Blue cancels your coverage in this health plan under an individual contract, a notice will be sent to you that will tell you the specific reason(s) that Blue Cross Blue Shield HMO Blue is canceling your individual contract. Blue Cross Blue Shield HMO Blue will cancel your coverage in this health plan under an individual contract only when one of the following situations occurs.  You Commit Misrepresentation or Fraud. Your coverage in this health plan will be canceled, or in some cases Blue Cross Blue Shield HMO Blue may limit your benefits, if you have committed misrepresentation or fraud. For example, you gave false or misleading information on the enrollment form. Or, you misused your ID card by letting another person who was not enrolled in this health plan attempt to get coverage. Your coverage in this health plan may be terminated when the fraud or misrepresentation is discovered or, as permitted by law, back to your effective date or the date of the misrepresentation or fraud. Your coverage in this health plan may be terminated retroactive to a date in the past (rather than on a current or future date) only if you committed fraud or made an intentional misrepresentation of a material fact. The termination date will be determined by Blue Cross Blue Shield HMO Blue.  You Commit Acts of Physical or Verbal Abuse. Your coverage in this health plan will be canceled if you commit acts of physical or verbal abuse that pose a threat to, or a threat to the health of, health care providers or other members or employees of Blue Cross Blue Shield HMO Blue or Blue Cross and Blue Shield of Massachusetts, Inc., and these acts are not related to your physical condition or mental condition. In this case, this termination will follow the procedures that have been approved by the Massachusetts Commissioner of Insurance.  You Fail to Comply with Plan Provisions. Your coverage in this health plan will be canceled if you fail to comply in a material way with any provision of the individual contract. For example, if you fail to provide information that Blue Cross Blue Shield HMO Blue requests related to your coverage in this health plan, Blue Cross Blue Shield HMO Blue may terminate your coverage.  This Health Plan Is Discontinued. Your coverage in this health plan will be canceled if Blue Cross Blue Shield HMO Blue discontinues this health plan. Blue Cross Blue Shield HMO Blue may discontinue this health plan for any reason as of a date approved by the Massachusetts Commissioner of Insurance. Medicare Program When you are eligible for Medicare and Medicare is allowed by federal law to be the primary payor, the coverage provided by this health plan will be reduced by the amount of benefits allowed under Medicare for the same covered services. This reduction will be made whether or not you actually receive the benefits from Medicare.