Xxxxxxx Xxxx CareFirst BlueChoice’s Service Area is a clearly defined geographic area in which CareFirst BlueChoice has arranged for the provision of health care services to be generally available and readily accessible to Members. CareFirst BlueChoice will provide the Member with a specific description of the Service Area at the time of enrollment. The Service Area is as follows: the District of Columbia; the state of Maryland; in the Commonwealth of Virginia, the cities of Alexandria and Fairfax, Arlington County, the town of Vienna and the areas of Fairfax and Xxxxxx Xxxxxxxx Counties in Virginia lying east of Route 123. SAMPLE If a Member temporarily lives out of the Service Area (for example, if a Dependent goes to college in another state), the Member may be able to take advantage of the CareFirst BlueChoice Away From Home Program. This Program may allow a Member who resides out of the Service Area for an extended period of time to utilize the benefits of an affiliated Blue Cross and Blue Shield HMO. This Program is not coordination of benefits. A Member who takes advantage of the Away From Home Program will be subject to the rules, regulations and plan benefits of the affiliated Blue Cross and Blue Shield HMO. If the Member makes a permanent move, he/she does not have to wait until the Annual Open Enrollment Period to change plans. Please call 000-000-0000 or visit xxx.xxxx.xxx for more information on the Away from Home Program. CareFirst BlueChoice, Inc. 000 Xxxxx Xxxxxx, XX Xxxxxxxxxx, XX 00000 000-000-0000 An independent licensee of the Blue Cross and Blue Shield Association ATTACHMENT A BENEFIT DETERMINATIONS AND APPEALS AMENDMENT This attachment contains certain terms that have a specific meaning as used herein. These terms are capitalized and defined in Section A below, and/or in the Individual Enrollment Agreement to which this document is attached. These procedures replace all prior procedures issued by CareFirst BlueChoice, which afford CareFirst BlueChoice Members recourse pertaining to denials and reductions of claims for benefits by CareFirst BlueChoice. These procedures only apply to claims for benefits. Notification required by these procedures will only be sent when a Member requests a benefit or files a claim in accordance with CareFirst BlueChoice procedures. An authorized representative may act on behalf of the Member in pursuing a benefit claim or appeal of an Adverse Benefit Determination. CareFirst BlueChoice may require reasonable proof to determine whether an individual has been properly authorized to act on behalf of a Member. In the case of a claim involving Urgent/Emergent Care, a Health Care Provider with knowledge of a Member's medical condition is permitted to act as the authorized representative. SAMPLE
Xxxxxxxx Xxxx Xxxxx, all sons of Late Sukur Xxx Xxxxx (13) Anjura Xxxxxx, wife of Late Sukur Xxx Xxxxx and (14) Sri Xxxxxxxxxx Xxxxxx, son of Late Xxxxxxxxx Xxxxxx, who has been represented by his lawfully constituted attorney Sri Xxxxxxxxx Xxxx Xxxxxxxx, son of Late Bilash Xxxxxxx Xxxxxxxx, by way of a Deed of Sale in Bengali language (kobala) dated 03rd June 2016 registered in the office of the District Sub-Registrar-III, North 24 Parganas and recorded in Book-I, Volume No. 1519-2016, at Pages 23140 to 23177, being No. 151901072 for the year 2016, sold, conveyed and transferred in favour of Smt. Lakshmi Xxxx Xxxxxxxx, wife of Sri Xxxxxxxxx Xxxx Xxxxxxxx, ALL THAT (1) piece and parcel of Sali (agricultural) land measuring 12 (twelve) decimal, more or less, comprised in R.S./L.R. Dag No. 105, recorded under L.R. Khatian Nos. 291, 684, 247, 1696, 300, 1981, 175, 277, 1294 and 1383 and (2) piece and parcel of Sali (agricultural) land measuring 0.88 (zero point eight eight) decimal, more or less, equivalent to 383.64 (three hundred and eighty three point six four) square feet, more or less [out of total land measuring 08 (eight) decimal, more or less], being part of R.S./L.R. Dag No. 101, recorded in L.R. Khatian No. 1811, both aggregating to land measuring 12.88 (twelve point eight eight) decimal, more or less, Mouza Paschim Icchapur, X.X. No. 29, Xx.Xx. No. 202, Police Station Barasat, within the limits of Xxxx No. 34 of Barasat Municipality, Xxx-Xxxxxxxxxxxx Xxxxxxxx Xxxxxxxxxxxx, Xxxxxxxx Xxxxx 00 Parganas (hereinafter referred as “Lakshmi’s First Land”).
