Assignment of Rights and Benefits. No right or benefit provided in this Agreement will be transferable by Executive except, upon his death, to a named Beneficiary as provided in this Agreement. No right or benefit provided for in the Agreement will be subject to anticipation, alienation, sale, assignment, pledge, encumbrance or charge, and any attempt to anticipate, alienate, sell, assign, pledge, encumber, or charge the same will be void. No right or benefit provided for in the Agreement will in any manner be liable for or subject to any debts, contracts, liabilities or torts of the person entitled to such benefits; provided, however, that the undistributed portion of any benefit payable hereunder shall at all times be subject to set-off for debts owed by Executive to the Bank.
Assignment of Rights and Benefits. I irrevocably assign and transfer to the center all rights, benefits, and any other interests in connection with any insurance plan, health benefit plan, or other source of payment for my care. This assignment shall include assigning and authorizing direct payment to the center of all insurance and health plan benefits payable for these outpatient services. I agree that the insurer or plan’s payment to the center pursuant to this authorization shall discharge its obligations to the extent of such payment. I understand that I am financially responsible for charges not paid according to this assignment, to the extent permitted by state and federal law. I agree to cooperate with, and take all steps reasonably, requested by, this center to perfect, confirm, or validate this assignment. Health Plan Contracts This center maintains a list of health plans with which it contracts within the state of Hawaii. A list of such plans is available upon request. We do not contract with out of state or international health plans. Therefore, at the time of service, you may request an estimate of charges. Once services are rendered, you are obligated to pay for such estimate. Based on level of care and treatment provided, you may receive a statement for additional charges once final reconciliation occurs. It is my responsibility to determine if the center providing services to me contracts with my current health plan. It is my responsibility to know the coverage (co‐payments, covered benefits) offered by my individual health plan. I certify that I have read the foregoing and received a copy thereof. I am the patient, the patient’s legal representative, or am otherwise authorized by the patient to sign the above and accept its terms on his/her behalf. Print Patient Name: Patient/Guardian Signature: Date: If signed by someone other than the patient, indicate relationship: Print Name (Guardian or legal representative): Signature (witness): Print Name (witness): FINANCIAL RESPONSIBILITY AGREEMENT BY PERSON(S) OTHER THAN THE PATIENT OR THE PATIENT’S LEGAL REPRESENTATIVE I agree to accept financial responsibility for services rendered to the patient and to accept the terms of the Financial Agreement, Assignment of Rights and Benefits, and Health Plan Contracts provisions above. Date: Print Name (financially responsible party): Signature (financially responsible party): Address: Signature (witness):
Assignment of Rights and Benefits. No Party to this Agreement may assign or convey any rights, benefits, obligations or liabilities arising from or connected herewith to any other party without the written consent of the other Party.
Assignment of Rights and Benefits. Effective as of November ___, 2009 (the “Closing Date”), Assignor hereby assigns, transfers and sets over unto Assignee, all of the right, title and internet of Debtor in, to and under the Savetherapeutics Contract.
Assignment of Rights and Benefits. Effective as of December ___, 2009 (the “Closing Date”), Debtor hereby assigns, transfers and sets over unto Assumptor, all of the right, title and internet of Debtor in, to and under the Xxxxxxx Contract.
Assignment of Rights and Benefits. Effective as of December ___, 2009 (the “Closing Date”), debtor hereby assigns, transfers and sets over unto Assumptor, all of the right, title and internet of Debtor in, to and under the Kessemeier Contract.
