Coventry Health Care of Georgia, Inc.
AMENDMENT TO:
Health Maintenance Organization (HMO)
Basic Conversion HMO Member Contract
(Form CHC-GA-ENHANCED-CONVERSION-PLANS-C-D-HMO-0507)
This Amendment (the “Amendment”), effective as of August 2, 2010, amends the Coventry Health Care
of Georgia, Inc. Basic Conversion HMO Member Contract (the Contract) to comply with the federal
Patient Protection and Affordable Coverage Act of 2010 and the federal Health Care and Education
Reconciliation Act of 2010 (collectively, the “Act”).
Capitalized terms not otherwise defined in this Amendment shall have the meaning set forth in the
Contract.
To the extent any provision of this Amendment conflicts with any of the provisions of the Contract, the
provisions of this Amendment shall govern. Except for the amendments made hereby, the Contract
remains in full force and effect.
The HMO Member Contract is hereby amended to reflect the following changes:
Section 2, ENROLLMENT AND ELIGIBILITY, Subsection 2.1.2, Dependent Eligibility, is hereby
deleted in its entirety and replaced with the following new Subsection 2.1.2:
2.1.2
Dependent Eligibility. To be eligible to be enrolled as a Dependent, an individual must be the lawful
spouse of the Subscriber, or be an unmarried child of the Subscriber or the Subscriber’s spouse including:
a.
Children under age twenty-six (26) who are either the birth children of the Subscriber or the
Subscriber’s spouse or legally adopted by or placed for adoption with the Subscriber or Subscriber’s
spouse;
b.
Children under age twenty-six (26) for whom the Subscriber or the Subscriber’s spouse is required to
provide health care coverage pursuant to Qualified Medical Child Support;
c.
Children under age twenty-six (26) for whom the Subscriber or the Subscriber’s spouse is the courtappointed legal guardian; and
CHC-GA-ENHANCED-CONVERSION-PLANS-C-D-HMO-0507 HCR Amend 0810
Coventry Health Care of Georgia, Inc. –
Amendment to Health Maintenance Organization Enhanced Conversion Member Contract
d.
Children twenty-six (26) or older who are either the birth or adopted children of the
Subscriber or the Subscriber’s spouse, are mentally or physically incapable of earning a
living and who are chiefly dependent upon the Subscriber for support and maintenance,
provided that: the onset of such incapacity occurred before age twenty-six (26), proof of
such incapacity is furnished to Us by the Subscriber upon enrollment of the person as a
Dependent child or at the onset of the Dependent child’s incapacity prior to age twenty-six
(26) and annually thereafter.
Notwithstanding the above, a common law spouse qualifies as a spouse under this Agreement
only if his/her spousal status is affirmed by a court of competent jurisdiction.”
Section 10, DEFINITIONS, is modified to add the following definition:
“Preventive Services”
The services set forth in Section 2713(a)(1) of the federal Public Health Service Act.
To the extent any term or condition related to Covered Services and set forth in the Contract (or any
attachment, rider, or schedule of benefits) conflicts with the Act, such term or condition shall be
interpreted to comply with the Act.
COVENTRY HEALTH CARE OF GEORGIA, INC.
Thomas Davis
Chief Executive Officer
Coventry Health Care of Georgia, Inc.
CHC-GA-ENHANCED-CONVERSION-PLANS-C-D-HMO-0507 HCR Amend 0810