How to Terminate Your Coverage

If it becomes necessary for you to terminate your Inclusive Health Policy, you are responsible for notifying us promptly.

According to your Inclusive Health Policy, your policy will terminate:

• On the date You are no longer a Resident of North Carolina;
• At the end of the month You request termination of this Policy in writing, or if later, the date such notice is received by Us;
• On the date of Your death;
• On the date that North Carolina law requires cancellation of this Risk Pool Policy;
• On the date that the Lifetime Maximum Benefit is reached;
• 30 days after We make an inquiry concerning Your eligibility or Residence to which You do not reply;
• On the premium due date if premium is not paid when due, subject to the Grace Period provision;
• On the date there is fraud or material misrepresentation made by or with the knowledge of the Covered Person in applying for this coverage or filing a claim for benefits, subject to the Time Limit on Certain Defenses provision;
• At the end of the month for which Risk Pool premium has been paid, following the date that You cease to meet the eligibility requirements of the Risk Pool, as described in the Loss of Eligibility provision;
• On the date that We cease to offer this particular type of policy in North Carolina, as allowed by state law and subject to Our provision of 90 days advance written notice of such termination to You and the beneficiary. In such case You will have the opportunity at the time of termination to purchase any other policy We offer in North Carolina; or
• On the date that We cease to do business in the individual insurance market in North Carolina, as allowed by state law and subject to our provision of 180 days advance written notice of such termination to You and the beneficiary.


We will provide you with a certification of Creditable Coverage at the time You cease to be covered under this Policy. A certification of Creditable Coverage is a written certification of the period of Creditable Coverage under a health plan and any waiting period and affiliation period imposed with respect to the individual for any coverage under that plan. You may also request a certification of Creditable Coverage from Us within 24 months after the date of termination.

Return of Premium
If, upon review of Your application, You are found to be ineligible for the coverage provided by this Policy, any premium received will be returned to You and the Policy will be void from the Effective Date. Your unearned premium if there is any, will be returned to You at the end of the month in which You request termination of this Policy in writing, or if later, the end of the month during which such notice is received by Us:


• If it becomes necessary for You to terminate your Inclusive Health Policy, You are responsible for notifying us promptly.
• If You elect to voluntarily cancel your Inclusive Health Coverage, We must receive written notification by the 20th of the month prior to the day You are requesting Your coverage to end.
• Requests must be submitted in writing and include Your name and member identification number.
• Mail Requests to PO BOX 2302, Mt. Clemens MI or fax to: 586-226-3112.


To notify us you should:

1. Fill out an IH Member Change form. A Member Change Form is available at:


• State Option Change Form
• Federal Option Change Form

     An on-line Change Form is also available at:


• State Option Change Form Online
• Federal Option Change Form Online


2. Fax the Inclusive Health Member Change for to: (586) 226-3112.