AMERICAN SPECIALTY HEALTH PLANS GROUP SUBSCRIBER AGMT 1998

~ ~ 2.03 Dependent Eligibility. A Dependent's eligibility for Enrollment is contingent upon Subscriber's eligibility for enrollment in this Health Plan, i.e., a Dependent child of an eligible Subscriber who meets the eligibility requirements set forth in Section 2.02 may be enrolled as a Dependent. Coverage for newborn children of Subscribers begins at birth. Coverage for adopted children of Subscribers begins from the date physical custody of the child is obtained by the Subscriber. ASHP may require Subscriber to present evidence that physical custody has been obtained, including, without limitation, adoption agency documentation. In order for coverage to continue beyond thirty-one (31) days after the date of birth, or, in the case of adoption, thirty-one (31) days past the date physical custody is obtained, an Enrollment Form for the Dependent must be submitted to Group within thirty-one (31) days of the date of birth or in the case of adoption, the date physical custody is obtained. Eligibility for an adopted child ends if the placement is interrupted before legal adoption and the child is removed from the Subscriber. Newborn care is not a covered benefit at any time if the mother of the newborn child is a Dependent child of the Subscriber. Eligible Dependent children must be unmarried and under the limiting age according to health plan guidelines. Dependent unmarried children who are enrolled in an institution of higher education may continue as eligible Dependents through the limiting age according to health plan guidelines provided proof of Dependent status is .submitted to ASHP on a periodic basis, as requested by ASHP. Dependent unmarried children who are incapable ofself-sustaining employment by reason of mental retardation or physical handicap and who are dependent upon Subscriber for support and maintenance are eligible for continuing Membership in this Health Plan, provided proof of such incapacity and dependency is provided to ASHP within thirty (30) days of the child's attainment of the limiting age according to health plan guidelines. ASHP may periodically require proof of Dependent's Incapacity and dependency, but not more frequently than annually after the two (2) year period following the child's attainment of the limiting age and condition. Such proof shall consist of a written statement by a licensed psychologist, psychiatrist, or other physician to the effect that such Dependent is incapable of self-sustaining employment by reason of mental retardation or physical handicap. An application to enroll Dependents who become Dependents as a result of marriage to a Subscriber must be made within thirty (30) days of the date of marriage. 2.04 Commencement of Coverage. This Health Plan shall commence on the date ASHP accepts Member's Enrollment application or documentation from Group, and verifies Member's eligibility through the Eligibility Tape provided by Group. ASHP's acceptance of Member's Enrollment application is contingent upon receipt of the applicable Health Plan Premium payment. 2.05 Member's Eligibility Not Affected by Health Status. A Member otherwise eligible and duly enrolled hereunder shall not be terminated from this Health Plan due to the Member's health status or need for Chiropractic Services. 3. GROUP OBLIGATIONS. NOTICES AND HEALTH PREMIUMS. 3.01 Notices to ASHP. Group shall forward all completed or amended Enrollment Forms or other required documents to ASHP for processing within thirty (30) days after Group receives the form from the Member. Group acknowledges that any Enrollment applications or other required documentation not forwarded to ASHP within thirty (30) days may be rejected by ASHP. Group shall forward all notices of termination to ASHP within thirty (30) days after Member loses eligibility or elects to terminate Membership under this Agreement. Group shall be responsible for any Member Health Plan Premiums through the last day of the month in which notice of termination is received by ASHP. Group shall also submit to ASHP on or before the first Friday of each month an Eligibility Tape.