GUARANTEED RENEWABLE. The Agreement is guaranteed renewable and may be renewed by payment of the premium within thirty-one (31) days after the first day of the month for which payment must be made. Coverage continues for one (1) month from the effective date of the Agreement and from month to month thereafter until terminated in accordance with the Agreement. Non-renewal shall not be based on the deterioration of the mental or physical health of any individual covered under the Agreement.
GUARANTEED RENEWABLE. Upon the payment of the applicable rate, the HMO agrees to make payment for those services as set forth in this Subscriber Agreement. Subject to the right of the HMO to terminate coverage in accordance with Section EL - Eligibility, Change And Termination Rules Under The Plan. This Agreement is guaranteed renewable and may be renewed by payment of renewal Premiums within thirty (30) days after the first day of the month for which payment must be made. Coverage continues for one month from the effective date of the Agreement and from month to month thereafter until terminated as provided in Section EL - Eligibility, Change And Termination Rules Under The Plan. Non-renewal shall not be based on the deterioration of mental or physical health of any individual covered under this Agreement. Subject to the approval of the Pennsylvania Insurance Department, the HMO may adjust Premium rates. Any change in the Premium rate shall become applicable for Subscribers upon the expiration of the period covered by the Subscriber's current payment at the time of such change. TABLE OF CONTENTS WELCOME 1 How To Contact Us 1 Retail Centers 2 Member Identification (ID) Card 2 SECTION DE - DEFINITIONS 4 SECTION MC - USING THE HMO SYSTEM 16 SECTION CM – CLINICAL MANAGEMENT 18 Utilization Management 18 Care Management 20 Delegation of Utilization Review Activities and Criteria 22 Disease Management Programs 22 Maternity Management Program 22 Quality Management Program 22 Health Education and Wellness Programs 23 How We Evaluate New Technology 23 Alternative Treatment Plans 24 SECTION ACC - ACCESS TO PRIMARY CARE, SPECIALIST AND HOSPITAL CARE NETWORK ........................................................................................................................................................................... 25 Direct Access to Certain Care 25 Selection of a Primary Care Physician 25 How to Obtain a Specialist Referral 25 How to Obtain a Standing Referral 26 Designating a Referred Specialist as a Primary Care Physician 26 Changing Your Primary Care Physician 27 Changing Your Referred Specialist 27 Provider Directory 27 Continuity of Care 27 Preauthorization for Non-Participating Providers 28 Hospital Admissions 28 Recommended Plan of Treatment 29 Member Liability 29 Limitation of the HMO’s Liability 29 Right to Recover Payments Made In Error 30 SECTION ER - EMERGENCY, URGENT CARE, FOLLOW-UP CARE 31 What are Emergency Services 31 What Is Urgent Care? 31 Out-Of-Area Servic...
GUARANTEED RENEWABLE. Guaranteed renewable means that this contract will renew each year on the anniversary date unless terminated earlier in accordance with contract terms. You may keep this contract in force by timely payment of the required premiums. We may decide not to renew as of the renewal date if: (1) we decide not to renew all contracts issued on this form, with the same type and level of benefits, to residents of the state where you then live; or (2) there is fraud or an intentional material misrepresentation made by or with the knowledge of a member in filing a claim for contract benefits. Rate changes are effective on a member’s annual renewal date and will be based on each member’s attained age, family structure, geographic region, tobacco usage and benefit plan at the time of renewal. We have the right to change premiums. We will notify the member in writing at least 45 days prior to the renewal date of any change in premium rates. If we discontinue offering and decide not to renew all policies issued on this form, with the same type and level of benefits, for all residents of the state where you reside, we will provide a written notice to you at least 90 days prior to the date that we discontinue coverage. At least 45 days advanced written notice of any plan to take an action or make a change permitted by this clause will be delivered to you at your last address as shown in our records. We will make no change in your premium solely because of claims made under this contract or a change in a member's health. While this contract is in force, we will not restrict coverage already in force.
GUARANTEED RENEWABLE. PREMIUM SUBJECT TO CHANGE Subject to the right of the Plan to cancel, terminate, nonrenew or void coverage in accordance with Section I., this Subscription Agreement is guaranteed renewable and may be renewed by payment of the applicable subscription rate. Subject to the approval of the Delaware Department of Insurance, the Plan may adjust the subscription rates paid by all Subscribers covered under this Subscription Agreement. In addition, the required subscription rate due under this Agreement may also change based upon the current attained age of the Subscriber. For additional information, refer to Sections I and VI of this Agreement.
GUARANTEED RENEWABLE. The Policy is guaranteed renewable as to Insured Persons. For purposes of this Policy, “
GUARANTEED RENEWABLE. Coverage under this Agreement is guaranteed renewable except as permitted to be canceled, rescinded, or not renewed under applicable State and federal law, provided the Member is a Qualified Individual as determined by the Exchange. The Member may renew this Agreement by payment of the renewal Premium by the end of the grace period of the Premium due date, provided the following requirements are satisfied:
GUARANTEED RENEWABLE. This means You have the right, subject to the terms of this Policy, to continue this Policy as long as You pay the premiums on time. New York Life cannot change any of the terms of this Policy on its own, except that in the future it may increase premiums You pay. We cannot change this Policy without Your consent, unless required by federal or state law, but We may change the premium rates. Premium Rate Changes New York Life has the right to change the premium rates for this Policy. Premium rate increases are subject to Insurance Department approval, will be made only on a Class basis and will take effect on a Policy Anniversary Date. We will notify You at least 60 days prior to such premium change. Premiums may also change based on any changes that You request to Benefits, as described in the Increase in Benefits and Lower Benefit Plan provisions of the Policy.
GUARANTEED RENEWABLE. The Policy is guaranteed renewable and shall renew monthly upon payment of the required premium. Non-renewal shall not be based on the deterioration of mental or physical health of any individual covered under the Policy. Premium will change only as described in E.3 below.
GUARANTEED RENEWABLE. PREMIUM SUBJECT TO CHANGE Subject to the right of the Plan to cancel, terminate, nonrenew or void coverage in accordance with Section I., this Subscription Agreement is guaranteed renewable and may be renewed by payment of the applicable subscription rate. Subject to the approval of the Pennsylvania Insurance Department, the Plan may adjust the subscription rates paid by all Subscribers covered under this Subscription Agreement. In addition, the required subscription rate due under this Agreement may also change based upon the current attained age of the Subscriber. For additional information, refer to Sections I. and VI. of this Agreement. This Agreement is non-participating in any divisible surplus of premium.
GUARANTEED RENEWABLE. The annual premium for this rider is shown on the Policy Data page. We can change the premium amount only: (1) After the rider has been in force for three years; and (2) If the change applies to all policies with like benefits insuring the same Risk Class.
