UNDERSTANDING THE BASICS OF YOUR COVERAGE Clause Samples

UNDERSTANDING THE BASICS OF YOUR COVERAGE. THIS IS A LIMITED BENEFIT POLICY PROVIDING COVERAGE FOR NEEDLE STICKS ONLY. PLEASE READ CAREFULLY. Blue Cross and Blue Shield of Louisiana issues this Student Group Health Insurance Limited Benefit Plan to the University shown in the Schedule of Benefits. A copy of this Benefit Plan provided to a Subscriber serves as the Subscriber’s certificate of coverage. As of the Benefit Plan Date shown in the University’s Schedule of Benefits, We agree to provide the Benefits specified herein for Subscribers of the University. This Benefit Plan replaces any others previously issued to the University as of the Benefit Plan Date or amended Benefit Plan Date. This Plan describes Your Benefits, as well as Your rights and responsibilities under the Plan. We encourage You to read this Benefit Plan carefully. You should call Us if You have questions about Your coverage or any limits to the coverage available to You. Many of the sections of this Benefit Plan are related to other sections of this Plan. You may not have all of the information You need by reading just one section. Please be aware that Your Physician does not have a copy of Your Benefit Plan, and is not responsible for knowing or communicating Your Benefits. Except for necessary technical terms, We use common words to describe the benefits provided under this Benefit Plan. “We,” “Us” and “Our” means BLUE CROSS AND BLUE SHIELD OF LOUISIANA. Capitalized words are defined terms in Article II - “Definitions.” A word used in the masculine gender applies also in the feminine gender, except where otherwise stated. This Benefit Plan is a limited benefit blanket group health insurance plan written by Blue Cross and Blue Shield of Louisiana and issued to the University. It is a student health insurance policy intended to cover University’s Eligible Students as defined in the Benefit Plan. This Plan provides student coverage for Needle Sticks only. It is not a comprehensive medical plan. In order to maximize Your student health service benefits, You may wish to initially visit LOUISIANA STATE UNIVERSITY HEALTH SCIENCE CENTERS STUDENT HEALTH SERVICE (LSUHSC) for Your Medical care. Some medical services for students are provided as part of Your student health fee. If You require health services not available at LSUHSC, You may want to seek care from a Preferred Care (PCare) PPO Network Provider because Your cost will generally be lower than seeing a Non-Network Provider. This is a network policy. Subscribers have the right t...
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UNDERSTANDING THE BASICS OF YOUR COVERAGE. Blue Cross and Blue Shield of Louisiana (Company) issues this health Contract to the Subscriber shown in the Schedule of Benefits. As of the Benefit Plan Date shown in the Subscriber’s Schedule of Benefits, We agree to provide the Benefits specified herein for Subscribers and their enrolled Dependents. This Contract replaces any others previously issued to the Subscriber, as of the Benefit Plan Date or the amended Benefit Plan Date. This Plan describes Your Benefits, as well as Your rights and responsibilities under the Plan. We encourage You to read this Contract carefully. You should call Us if You have questions about Your coverage, or any limits to the coverage available to You. Many of the sections of this Contract are related to other sections of this Plan. You may not have all of the information You need by reading just one section. Please be aware that Your Physician does not have a copy of Your Contract, and is not responsible for knowing or communicating Your Benefits to You.
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Related to UNDERSTANDING THE BASICS OF YOUR COVERAGE

  • When Your Coverage Ends Coverage under this plan is guaranteed renewable. It can only be canceled by us for the following reasons: • if you leave your place of employment; • if you decide to discontinue coverage. Inform your employer prior to the requested date of cancellation and your employer will notify us. If we do not receive your notice prior to the requested date of cancellation, you or your employer may be responsible for paying another month’s premium; • if the required premium is not paid within one month of the due date. We will mail you a notice of discontinuance along with information about enrolling in an individual healthcare plan; • if you or a covered dependent no longer qualifies as an eligible person; • if we no longer offer this type of coverage; • if your employer contracts with another insurer or entity to provide or administer benefits for the covered healthcare services provided by this agreement; • if fraud is determined by us. See Rescission of Coverage section below for additional details; If your healthcare coverage is terminated for one of the reasons listed above, we will send you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why your healthcare coverage has ended. When your coverage ends, you may apply for individual healthcare coverage directly from BCBSRI or through HSRI. You must meet the eligibility requirements and we must receive required enrollment information within sixty (60) days from the date your group coverage ended along with required premium. If you do not reside in Rhode Island, you are not eligible to enroll in an individual plan from BCBSRI or HSRI. You may be able to obtain coverage through an insurance company in the state in which you reside. Rescission is a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described above); or • is due to non-payment of premiums, which can have a retroactive cancellation effect. We may rescind your coverage if you or your dependents commit fraud. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) or intentional misrepresentation of a material fact. Any benefit paid in the past will be voided. You will be responsible to reimburse us for all costs and claims paid by us. We must provide you a written notice of a rescission at least thirty (30) days in advance. Except for non-payment, we will not contest this policy after it has been in force for a period of two (2) years from the later of the effective date of this agreement or the latest reinstatement date.

  • When Your Coverage Begins Your coverage will begin on the first day of the month following your eligibility date as long as we receive required enrollment information within the first thirty (30) days following your eligibility date and the premium is paid. If you or your dependents fail to enroll at this time, you cannot enroll in the plan unless you do so through an Open Enrollment Period or a Special Enrollment Period.

  • What Will Happen After We Receive Your Letter When we receive your letter, we must do two things:

  • Prior Understanding This Agreement and the other Loan Documents supersede all prior understandings and agreements, whether written or oral, between the parties hereto and thereto relating to the transactions provided for herein and therein, including any prior confidentiality agreements and commitments.

  • Happen After We Receive Your Letter When we receive your letter, we must do two things: