Part 12 – Individual Policy (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 108 qualified health care coverage. If you do not request the change within the time required, you will have to wait until the next annual open enrollment period to make the change. All changes are allowed only when they comply with the conditions outlined in the individual contract and with Blue Cross Blue Shield HMO Blue policies. (If you enrolled in this health plan through the Massachusetts Health Connector, the Health Connector’s policies may apply in addition to or in place of Blue Cross Blue Shield HMO Blue policies. If this applies to you, you must call the Health Connector directly for any questions about any membership changes you need to make such as a change to your name or address.) Termination of Individual Coverage Loss of Eligibility for Individual Coverage When your eligibility for an individual contract ends, your coverage in this health plan under an individual contract will be terminated as of the date you lose eligibility. You will lose eligibility for coverage in this health plan under an individual contract when any one of the following situations occurs.  Your Dependent Status Ends. Your coverage in this health plan under an individual contract will end when you lose your status as an eligible dependent under the subscriber’s individual contract. In this case, you may wish to enroll as a subscriber under an individual contract. Or, you may be able to enroll in another Blue Cross Blue Shield HMO Blue health plan or a health plan offered by Blue Cross and Blue Shield of Massachusetts, Inc. For help, you can call the Blue Cross Blue Shield HMO Blue customer service office. They will tell you which health plans are available to you.  You Move Out of the State. Your coverage in this health plan under an individual contract will end when you move permanently out of Massachusetts. In this case, you may be able to enroll in another Blue Cross and/or Blue Shield Plan’s health plan. For help, you can call the Blue Cross Blue Shield HMO Blue customer service office. They will help you with your options. Termination of Individual Coverage by the Subscriber Your coverage in this health plan under an individual contract will end when any one of the following situations occurs.  Subscriber Terminates Coverage. The subscriber may cancel coverage in this health plan under an individual contract at any time and for any reason. To do this, the subscriber must send a written request to Blue Cross Blue Shield HMO Blue. The termination date will be effective 15 days after the date that Blue Cross Blue Shield HMO Blue receives the termination request. Or, the subscriber may ask for a specific termination date. In this case, Blue Cross Blue Shield HMO Blue must receive the request at least 15 days before that requested termination date. Blue Cross Blue Shield HMO Blue will return to the subscriber any premiums that are paid for a time after the termination date.  Subscriber Fails to Pay Premiums. Your coverage in this health plan under an individual contract will be terminated when the subscriber fails to pay their premium to Blue Cross Blue Shield HMO Blue within 35 days after it is due. If Blue Cross Blue Shield HMO Blue does not get the full premium on or before the due date, Blue Cross Blue Shield HMO Blue will stop claim payments as of the last date through which the premium is paid. Then, if Blue Cross Blue Shield HMO Blue does not get the full premium within this required time period, Blue Cross Blue Shield HMO Blue will cancel your coverage in this health plan under an individual contract. The termination date will be the last date through which the premium is paid. (If you enrolled in this health plan through the Massachusetts Health Connector, you make your payments to the Health Connector. The Health Connector will send all notices to the subscriber related to non-payment of your premium.)