Common use of Time Limit on Certain Defenses Clause in Contracts

Time Limit on Certain Defenses. After 2 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 2-year period. We must provide 30 days’ notice of rescission or termination of coverage to any person affected. The notice will include the reason for rescission or termination. This policy does not have a pre-existing condition exclusion. Conformity with Applicable Law Any provision of the Policy which, on its effective date, is in conflict with an applicable federal law or applicable law of the State of Indiana, is amended to conform with the minimum requirements of that law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:

Time Limit on Certain Defenses. After 2 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 2-year period. We must provide 30 days’ notice No claim for loss incurred or disability commencing after the date of rescission issue of this policy will be reduced or termination denied on the grounds that a disease or physical condition existed prior to the effective date of coverage to any person affected. The notice will include the reason for rescission or terminationof this policy. This policy does not have a contains no pre-existing condition exclusionconditions. Conformity with Applicable Law Any provision of the Policy which, on its effective dateEffective Date, is in conflict with an applicable federal law or applicable law of the State of Indianastate law, is amended to conform with the minimum requirements of that law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:: • The Policyholder's name and address. • The patient's name and age. • The number stated on your ID card. • The name and address of the provider of the service(s). • The name and address of any ordering Physician. • A diagnosis from the Physician. • An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge. • The date the Injury or Illness began. • A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s). The above information should be filed with us at the address on your ID card. When filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: [Cigna Pharmacy Service Center PO Box 188053 Chattanooga, TN 37422-8053] Payment of Any Claim Payment of any claim will be made to the person rendering the services, unless the Insured furnishes paid receipts with his proof of claim. If the Insured dies before all benefits have been paid, the remaining benefits may be paid to any relative of the Insured or to any person or corporation appearing to the Company to be entitled to payments. The Company shall discharge its liability by such payments.

Time Limit on Certain Defenses. After 2 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 2-year period. We must provide 30 days’ notice No claim for loss incurred or disability commencing after the date of rescission issue of this policy will be reduced or termination denied on the grounds that a disease or physical condition existed prior to the effective date of coverage to any person affected. The notice will include the reason for rescission or termination. This policy does not have a pre-existing condition exclusionof this policy. Conformity with Applicable Law Any provision of the Policy which, on its effective dateEffective Date, is in conflict with an applicable federal law or applicable law of the State of Indianastate law, is amended to conform with the minimum requirements of that law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:: • The Policyholder's name and address. • The patient's name and age. • The number stated on your ID card. • The name and address of the provider of the service(s). • The name and address of any ordering Physician. • A diagnosis from the Physician. • An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge. • The date the Injury or Illness began. • A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s). The above information should be filed with us at the address on your ID card. When filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: [Cigna Pharmacy Service Center PO Box 188053 Chattanooga, TN 37422-8053] Payment of Any Claim Payment of any claim will be made to the person rendering the services, unless the Insured furnishes paid receipts with his proof of claim. If the Insured dies before all benefits have been paid, the remaining benefits may be paid to any relative of the Insured or to any person or corporation appearing to the Company to be entitled to payments. The Company shall discharge its liability by such payments.

Time Limit on Certain Defenses. After 2 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 2-year period. We must provide 30 days’ notice No claim for loss incurred or disability commencing after two years from the date of rescission issue of this policy will be reduced or termination denied on the grounds that a disease or physical condition existed prior to the effective date of coverage to any person affected. The notice will include the reason for rescission or terminationof this policy. This policy does not have a contains no pre-existing condition exclusionconditions. Conformity with Applicable Law Any provision of the Policy which, on its effective date, is in conflict with an applicable federal law or applicable law of the State of Indianastate law, is amended to conform with the minimum requirements of that state’s or federal law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:: ● The Policyholder's name and address. ● The patient's name and age. ● The number stated on your ID card. ● The name and address of the provider of the service(s). ● The name and address of any ordering Physician. ● A diagnosis from the Physician. ● An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge. ● The date the Injury or Illness began. ● A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s). The above information should be filed with us at the address on your ID card. When filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: Cigna Pharmacy Service Center [P.O. Box 188053 Chattanooga, TN 37422-8053] Payment of Any Claim Payment of any claim will be made to the person rendering the services, unless the Insured furnishes paid receipts with his proof of claim. If the Insured dies before all benefits have been paid, the remaining benefits may be paid to any relative of the Insured or to any person or corporation appearing to the Company to be entitled to payments. The Company shall discharge its liability by such payments.

Time Limit on Certain Defenses. After 2 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 2-year period. We must provide 30 days’ notice No claim for loss incurred or disability commencing after two years from the date of rescission issue of this policy will be reduced or termination denied on the grounds that a disease or physical condition existed prior to the effective date of coverage to any person affected. The notice will include the reason for rescission or terminationof this policy. This policy does not have a contains no pre-existing condition exclusionconditions. Conformity with Applicable Law Any provision of the Policy which, on its effective dateEffective Date, is in conflict with an applicable federal law or applicable law of the State of Indianastate law, is amended to conform with the minimum requirements of that law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:: • The Policyholder's name and address. • The patient's name and age. • The number stated on your ID card. • The name and address of the provider of the service(s). • The name and address of any ordering Physician. • A diagnosis from the Physician. • An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge. • The date the Injury or Illness began. • A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s). The above information should be filed with us at the address on your ID card. When filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: [Cigna Pharmacy Service Center PO Box 188053 Chattanooga, TN 37422-8053] Payment of Any Claim Payment of any claim will be made to the person rendering the services, unless the Insured furnishes paid receipts with his proof of claim. If the Insured dies before all benefits have been paid, the remaining benefits may be paid to any relative of the Insured or to any person or corporation appearing to the Company to be entitled to payments. The Company shall discharge its liability by such payments.

Time Limit on Certain Defenses. After 2 3 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 23-year period. We must provide 30 days’ notice of rescission or termination of coverage to any person affected. The notice will include the reason for rescission or termination. This policy does not have a pre-existing condition exclusion. Conformity with Applicable Law Any provision of the Policy which, on its effective date, is in conflict with an applicable federal law or applicable law of the State of Indianalaw, is amended to conform with the minimum requirements of that law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal Claims Appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:: • The Policyholder's name and address. • The patient's name and age. • The number stated on your ID card. • The name and address of the provider of the service(s). • The name and address of any ordering Physician. • A diagnosis from the Physician. • An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge. • The date the Injury or Sickness began. • A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s). The above information should be filed with us at the address on your ID card. When filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: [Cigna Pharmacy Service Center PO Box 188053 Chattanooga, TN 37422-8053] Payment of Any Claim Payment of any claim will be made to the person rendering the services, unless the Insured furnishes paid receipts with his proof of claim. If the Insured dies before all benefits have been paid, the remaining benefits may be paid to any relative of the Insured or to any person or corporation appearing to the Company to be entitled to payments. The Company shall discharge its liability by such payments.

Time Limit on Certain Defenses. After 2 years from the effective date of coverage no misstatements, except fraud or intentional misrepresentation of material fact, made by the applicant in the application for coverage shall be used to void the coverage or to deny a claim for loss incurred or disability commencing after the end of the 2-year period. We must provide 30 days’ notice No claim for loss incurred or disability commencing after two years from the date of rescission issue of this policy will be reduced or termination denied on the grounds that a disease or physical condition existed prior to the effective date of coverage to any person affected. The notice will include the reason for rescission or terminationof this policy. This policy does not have a contains no pre-existing condition exclusionconditions. Conformity with Applicable Law Any provision of the Policy which, on its effective date, is in conflict with an applicable federal law or applicable law of the State of Indianastate law, is amended to conform with the minimum requirements of that state’s or federal law. If You Receive Covered Health Services from a Network Provider We pay Network providers directly for your Covered Medical Expenses. If a Network provider bills you for any Covered Medical Expenses, contact us. However, you are responsible for meeting any applicable deductible and for paying any required Copayments and Coinsurance to a Network provider at the time of service, or when you receive a bill from the provider. If You Receive Covered Health Services from a Non-Network Provider This Policy does NOT pay benefits for Covered Medical Expenses from a non-Network provider, except for an Emergency or if we refer you to a Non-Network provider. You are responsible for requesting payment from us. You must file the claim in a format that contains all the information we require, as described below. Notice of Claim Written notice of claim must be given to Us within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured or beneficiary to Us, or to any of Our authorized agents with information sufficient to identify the Insured, shall be deemed notice to Us. Proof of Loss Written proof of claim must be given to the Company within 90 days from the date the expense was incurred or as soon as is reasonably possible. After receipt of a written notice of claim, the Company will furnish the claimant with forms for filing a proof of claim. If the forms are not furnished within 15 days after the written notice of claim was filed, the claimant shall be deemed to have complied with the requirement for filing proof of claim by virtue of having filed the written notice of claim. Written proof of claim must be given to the Company by the end of the Plan Year following the Plan Year in which the expense was incurred. However, when the Insured’s coverage terminates for any reason, written proof of claim must be given to the Company within 60 days of the date of termination of coverage, provided that the Policy remains in force. Claims will be paid on a timely basis by the Company upon receipt of complete written proof. Upon termination of the Policy, final claims must be received within 30 days of termination. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof within the required time and that proof was given as soon as was reasonably possible but no later than 1 year from the time proof of claim is otherwise required. For charges that are applied to satisfy a Deductible amount, the date of loss shall mean the date when the sum of the charges equals the Deductible amount. For other charges, the date of loss shall mean the date the charge is incurred. In the event that a claim is denied, and the Insured appeals said denial, the Company shall not be obligated to pay any part of said claim until a final determination has been made under the claims appeal procedure. The Company shall have the right (at its own expense) to require a claimant to undergo a physical examination when and as often as may be reasonable. Required Information When you request payment of Benefits from us, you must provide us with all of the following information:: ● The Policyholder's name and address. ● The patient's name and age. ● The number stated on your ID card. ● The name and address of the provider of the service(s). ● The name and address of any ordering Physician. ● A diagnosis from the Physician. ● An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge. ● The date the Injury or Illness began. ● A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s). The above information should be filed with us at the address on your ID card. When filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: MaxorPlus Clinical Department 000 X. Xxxx St. Amarillo, TX 79101 Payment of Any Claim Payment of any claim will be made to the person rendering the services, unless the Insured furnishes paid receipts with his proof of claim. If the Insured dies before all benefits have been paid, the remaining benefits may be paid to any relative of the Insured or to any person or corporation appearing to the Company to be entitled to payments. The Company shall discharge its liability by such payments.