HOW THE PLAN WORKS. The Plan is an open-end credit plan, including either or both a personal line of credit or credit card. We contemplate that, from time to time, you will use your Plan to borrow money from us (“credit advance”). To borrow under the Plan you must activate each of the Plan’s credit accounts individually. You may do this by submitting a credit request as explained below. If your request is approved, we will furnish you with a credit voucher providing information about your credit limit, annual percentage rate, any other applicable fees or charges, and any additional terms and conditions. In this Agreement, the capitalized word “Credit Voucher” means the document titled “Credit Voucher and Opening Disclosures” for a personal line of credit loan (“Line of Credit”) or “BECU Visa Credit Voucher and Opening Disclosures” for a Visa® credit card (“Card”).
HOW THE PLAN WORKS. This Section explains how your Health Benefit Plan works, how to access your Primary Care Practitioner to get Health Care Services, requirements you must follow when getting care and how to receive Covered Benefits under this Agreement. This plan is an “HMO” (Health Maintenance Organization). People who receive Health Care Benefits through an HMO are sometimes called “Enrollees” or “Subscribers. We strive to work closely with Subscribers, their Covered Dependents, and their health care Practitioners/Providers to prevent illness and provide quality, cost-effective health care. Because of this close working relationship, we consider our Enrollees and Subscribers to be Members of our health plan. We require that: ⮚ You must physically live in the State of New Mexico (our Service Area) unless you are a Dependent and meet all of the terms and conditions for such Coverage as outlined in the Refer to Eligibility, Enrollment and Effective Dates, Termination and Continuation of Coverage Section. ⮚ You must be under the age of 65. ⮚ You and/or your Dependents cannot be eligible for Medicare due to age, illness or disability. Refer to ⮚ All of your healthcare services are provided by In-Network Contract Practitioner/Providers, except for Urgent and Emergency Health Care Services situations. Please refer to the Benefits Section Accidental Injury / Urgent Care / Emergency Health Care Services / Observation / Trauma Services. ⮚ You select a Primary Care Physician (PCP) from the Provider Directory to coordinate all of your care. Refer to ⮚ You pay your pre-determined Cost Sharing (Deductible, Coinsurance and/or Copayment) at the time you receive Covered Services. We will reimburse the Practitioner/Provider the balance for Covered Se vices based upon Total Allowable Charges (some services may not require a Cost Sharing Deductible, Coinsurance and/or Copayment). Refer to your Summary of Benefits and Coverage to find Covered Services subject to Cost Sharing amounts. Important 🖐
HOW THE PLAN WORKS. Provider Information You are entitled to medical care and services from Participating Providers including Medically Necessary medical, surgical, diagnostic, therapeutic and preventive services that are generally and customarily provided in the Service Area. Some services may not be covered. To be covered, a service that is Medically Necessary must also be described in COVERED SERVICES AND BENEFITS. Even though a Physician or other Health Care Professional has performed, prescribed or recommended a service does not mean it is Medically Necessary or that it is covered under COVERED SERVICES AND BENEFITS. Some Covered Services may also require Preauthorization by HMO. Preauthorization processes will be conducted in accordance with Texas Insurance Code, chapter 4201, or in accordance with the laws in the state of Texas. Only services that are performed, prescribed, directed or authorized in advance by the PCP or HMO are covered benefits under this Certificate except Emergency Care or Covered Services provided to female Members, who may directly access an Obstetrician/Gynecologist in the same Limited Provider Network as their PCP for: 1) well woman exams; 2) obstetrical care; 3) care for all active gynecological conditions; and
HOW THE PLAN WORKS. All Non-OTETA employees driving a county vehicle will be issued a county permit based on a current and valid Florida driver’s license. This Safe Driver Plan shall reflect the same point system as that used by the Florida Division of Motor Vehicles, hereinafter referred to as the DMV. If the DMV changes its point system to reflect an upward or downward adjustment, or adds to or deletes violation currently listed, the Plan shall be adjusted in the same manner. Covered employees are required to report any citations in their district vehicles at the time of the occurrence, no later than the end of their duty day. Accidents in a district vehicle must be reported immediately to the work location supervisor/designee.
HOW THE PLAN WORKS. This Safe Driver Plan is based on a point system, whereby points are applied to a variety of driving violations. The accumulation of a certain number of points within a specific time period may result in disciplinary action against the employee. For employees covered by this Plan, it does not matter whether the points were assigned for violations involving the District vehicle, or the employee’s personal vehicle. If the DMV changes its point system to reflect an upward or downward adjustment, or adds to or deletes violations currently listed, the Plan shall be adjusted in the same manner. Covered employees are required to report all infractions in their personal vehicles, as well as District vehicles. Failure to do so may result in additional points, which increases the potential for disciplinary action.
HOW THE PLAN WORKS. This Section explains how to find Practitioners/Providers who are in our network (In- network), get Healthcare Services both In-network and Out-of-network, requirements you must follow when getting care and how to receive Covered Benefits under this Agreement. This plan is a Preferred Provider Organization (PPO) Healthcare Plan. Each time you need Healthcare Services, you can choose your Practitioners and Providers and the level of Covered Benefits that will apply to their charges. You will receive the highest level of Covered Benefits and the lowest cost to you when you obtain services from our In-network Practitioners/Providers. You still have the flexibility provided by the Out-of-network benefits to see any Practitioner/Provider you choose for many of your Healthcare Services. Under the Market Stabilization rule finalized on April 13, 2017, to the extent permitted by State law, Presbyterian Insurance Company Inc. may attribute to any past-due premium amounts owed to it the initial premium payment made in accordance with the terms of the health insurance policy to effectuate coverage, for coverage in the 12-month period preceding the effective date. This is done in an effort to prohibit abuse of the grace period. Be aware that failure to pay premiums in a preceding 12-month period may result in the group or individual’s inability to effectuate new coverage until past-due premium payments and initial premium payments are satisfied. PIC accepts premium and cost-sharing payments from the following third-party entities from plan enrollees (in the case of a downstream entity, to the extent the entity routinely collects premiums or cost-sharing): a Xxxx Xxxxx HIV/AIDS Program under title XXVI of the Public Health Service Act, an Indian tribe, tribal organization, or urban Indian organization, and a local state, of Federal government program, including a grantee directed by a government program to make payments on its behalf.
HOW THE PLAN WORKS. If you should die, your basic life insurance plan will pay a benefit to your appointed beneficiary, regardless of the cause of death. You may name anyone you choose to receive benefits payable under the plan in the event of your death. However, if you name a minor, a trustee must also be appointed. You may change your beneficiary designation at any time by contacting your Plan Administrator. BENEFITS PROVIDED Your basic life insurance coverage is equal to three times your annual earnings to a maximum of $100,000. (Amounts that are not an event multiple of $1,000 are rounded up to the nearest $1,000.) Your coverage will reduce by 50% on your 65th birthday. Waiver of Premium If you become totally disabled while insured and before your 65th birthday or earlier retirement, your life insurance coverage under the Basic Life plan will be continued without further payment of premiums. Your coverage will continue until you are no longer disabled, retire or reach age 65, whichever occurs first. Proof that you are totally disabled must be submitted to Great-West Life within 12 months from the onset of the disability, and periodically as requested by Great-West Life thereafter. Totally Disabled means that you are prevented from performing any work for compensation or profit or from following any gainful occupation. (However, if you are insured for Long Term Disability benefits by Great-West Life under this same master policy, the definition of total disability used to determine your eligibility for disability benefits, as described in this booklet, shall also apply when assessing your life insurance waiver of premium benefit.)
HOW THE PLAN WORKS. This Section explains how your Health Benefit Plan works, how to access your Primary Care Practitioner to get Health Care Services, requirements you must follow when getting care and how to receive Covered Benefits under this Agreement. This plan is an “HMO” (Health Maintenance Organization). People who receive Health Care Benefits through an HMO are sometimes called “Enrollees” or “Subscribers. We strive to work closely with Subscribers, their Covered Dependents, and their health care Practitioners/Providers to prevent illness and provide quality, cost-effective health care. Because of this close working relationship, we consider our Enrollees and Subscribers to be Members of our health plan. We require that: ⮚ You must physically live in the State of New Mexico (our Service Area) unless you are a Dependent and meet all of the terms and conditions for such Coverage as outlined in the Refer to Eligibility, Enrollment and Effective Dates, Termination and Continuation of Coverage
HOW THE PLAN WORKS. It is the purpose of the Plan to allow Participants to choose among the various benefits contained within the Plan in a manner that best meets their personal needs, and, further, to choose, to the maximum extent permitted by applicable law, between taxable and nontaxable compensation. The benefit options available for the Plan Years 2004, 2005 and 2006 and various rules relating to those options are set forth below:
HOW THE PLAN WORKS. 6 This Safe Driver Plan establishes a system whereby points are assessed to a variety of 7 common driving infractions/ violations/ accidents/ incidents. Generally, the more serious 8 the infraction/ violation/ accident/ incident, the higher the point value is. 9
