Claims and Payment of Claims Sample Clauses

Claims and Payment of Claims. A. Claim Forms. A claim form can be requested by calling the Member and Provider Service telephone number on the identification card during regular business hours. CareFirst shall provide claim forms for filing proof of loss to each claimant. If CareFirst does not provide the claim forms within fifteen (15) days after notice of claim is received, the claimant is deemed to have complied with the requirements of the policy as to proof of loss if the claimant submits, within the time fixed in the policy for filing proof of loss, written proof of the occurrence, character, and extent of the loss for which the claim is made. When a Member subject to a Medical Child Support Order does not reside with the Subscriber, CareFirst will 1. Send the non-insuring, custodial parent identification cards, claims forms, the applicable certificate of coverage or member contract, and any information needed to obtain benefits; 2. Allow the non-insuring, custodial parent or a provider of a Covered Service to submit a claim without the approval of the Subscriber; and 3. Provide benefits directly to: a) The non-insuring, custodial parent; b) The provider of the Covered Services, Covered Dental Services or Covered Vision Services; or c) The appropriate child support enforcement agency of any state or the District of Columbia.

Claims and Payment of Claims. A. Claim Forms CareFirst does not require a written notice of claims. A claim form can be requested by calling the Member and Provider Service telephone number on the identification card during regular business hours. CareFirst shall provide claim forms for filing proof of loss to each claimant or to the Group for delivery to the claimant. If CareFirst does not provide the claim forms within fifteen (15) days after notice of claim is received, the claimant is deemed to have complied with the requirements of the policy as to proof of loss if the claimant submits, within the time fixed in the policy for filing proof of loss, written proof of the occurrence, character, and extent of the loss for which the claim is made. When a child subject to a Medical Child Support Order or Qualified Medical Support Order does not reside with the Subscriber, CareFirst will 1. Send ID cards, claims forms, the applicable Evidence of Coverage, and any information needed to obtain benefits to the non-insuring custodial parent; 2. Allow the non-insuring custodial parent or a provider of a Covered Service to submit a claim without the approval of the Subscriber; and, 3. Provide benefits directly to the non-insuring parent, the provider of the Covered Services, or the appropriate child support enforcement agency of any State or the District of Columbia. B. Proof of Loss Written proof of loss shall be furnished to CareFirst within fifteen (15) months after the date of the loss. Failure to furnish the proof within the time required does not invalidate or reduce any claim if it was not reasonably possible to give proof within the required time, provided the proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity of the claimant, later than one (1) year from the time proof is otherwise required. C. Time of Payment of Claims Benefits payable under this policy for will not be paid more than thirty (30) days after receipt of written proof of loss.

Claims and Payment of Claims