How Your Covered Health Care Services Are Paid Sample Clauses

How Your Covered Health Care Services Are Paid. We will reimburse the lesser of the provider’s charges or the maximum benefit amount shown in the Summary of Medical Benefits.
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How Your Covered Health Care Services Are Paid. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. You must file all claims within one calendar year of the date you receive a covered health care service. Member submitted claims that arrive after this deadline are invalid unless: • it was not reasonably possible for you to file your claim prior to the filing deadline; AND • you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Any payments to you or the provider fulfill any responsibility of either the plan or Blue Cross & Blue Shield of Rhode Island under this agreement. Your benefits are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network providers file claims for you and must do so within one hundred and eighty (180) days of providing a covered health care service to you. Non-network providers may or may not file claims for you. If the non-network provider does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized xxxx including the following: • patient's name; • your member identification number; • the name, address, and telephone number of the provider who performed the service; • date and description of the service; AND • charge for that service. Please mail medical claims to: Blue Cross & Blue Shield of Rhode Island Attention: Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000
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How Your Covered Health Care Services Are Paid. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. You must file all claims within one calendar year of the date you receive a covered health care service. Member submitted claims that arrive after this deadline are invalid unless:  it was not reasonably possible for you to file your claim prior to the filing deadline; AND  you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Any payments to you or the provider fulfill any responsibility of either the plan or Blue Cross & Blue Shield of Rhode Island under this agreement. Your benefits are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network providers file claims for you and must do so within one hundred and eighty (180) days of providing a covered health care service to you.
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How Your Covered Health Care Services Are Paid. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization.
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Related to How Your Covered Health Care Services Are Paid

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • CONTRACTOR California Department of General Services Use Only CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) ✍ DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME BY (Authorized Signature) ✍ DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: ADDRESS Exhibit A Project Summary & Scope of Work

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for 130 workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this Section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Personnel Commission.

  • Citizen Volunteer or Community Service Leave Leave without pay may be granted for community volunteerism or service.

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Primary Care Clinic Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Health Care Compliance Neither the Company nor any Affiliate has, prior to the Effective Time and in any material respect, violated any of the health care continuation requirements of COBRA, the requirements of FMLA, the requirements of the Health Insurance Portability and Accountability Act of 1996, the requirements of the Women's Health and Cancer Rights Act of 1998, the requirements of the Newborns' and Mothers' Health Protection Act of 1996, or any amendment to each such act, or any similar provisions of state law applicable to its Employees.

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