TERMS OF YOUR COVERAGE. We provide the benefits described in this booklet only for eligible Members. The health care services are subject to the limitations, exclusions, Copayments, Deductibles and Coinsurance requirements specified in your Summary of Benefits and Coverage. This Certificate of Coverage supersedes any previously distributed Certificate of Coverage. Benefit payment for Covered Services or supplies will be made directly to whoever submits the claim. If the Provider submits the claim, we will make payment to the Provider. If you submit the claim, payment will be made directly to you and you are responsible for making payment to the Provider. We do not supply you with a Hospital or Physician. In addition, we are not responsible for any Injuries or damages you may suffer due to actions of any Hospital, Physician or other person. In order to process your claims, we may request additional information about the medical treatment you received and/or other health insurance you may have. This information will be treated confidentially. An oral explanation of your benefits by an Alliant employee is not legally binding. Any correspondence mailed to you will be sent to your most current address. You are responsible for notifying us of your new address.
TERMS OF YOUR COVERAGE. We provide the benefits described in this booklet only for eligible Members. The health care services are subject to the limitations, exclusions, Copayments, Deductibles and percentage payable requirements specified in this booklet. Any Group Alliant Contract or Certificate which you received previously will be replaced by this Contract. Benefit payment for Covered Services or supplies will be made directly to In-Network Providers. A Member may assign benefits to a provider who is not an In-Network Provider, but it is not required. If a Member does not assign benefits to an Out-of-Network Provider, any payment will be sent to the Member. We do not supply you with a Hospital or Physician. In addition, we are not responsible for any Injuries or damages you may suffer due to actions of any Hospital, Physician or other person. In order to process your claims, we may request additional information about the medical treatment you received and/or other group health insurance you may have. This information will be treated confidentially. An oral explanation of your benefits by an Alliant employee is not legally binding. Any correspondence mailed to you will be sent to your most current address. You are responsible for notifying us of your new address. General Information Fraudulent statements on Subscriber application forms and/or claims for services or payment involving all media (paper or electronic) may invalidate any payment or claims for services and be grounds for voiding the Subscriber’s coverage. This includes fraudulent acts to obtain medical services and/or Prescription Drugs. Both parties to this Contract (the employer and Alliant) are relieved of their responsibilities without breach, if their duties become impossible to perform by acts of God, war, terrorism, fire, etc. We will adhere to the employer’s instructions and allow the employer to meet all of the employer’s responsibilities under applicable state and federal law. It is the employer’s responsibility to adhere to all applicable state and federal laws and we do not assume any responsibility for compliance. Acts Beyond Reasonable Control (Force Majeure) Should the performance of any act required by this coverage be prevented or delayed by reason of any act of God, strike, lock-out, labor troubles, restrictive government laws or regulations, or any other cause beyond a party’s control, the time for the performance of the act will be extended for a period equivalent to the period of delay and non-...
