Acceptance of Group Agreement. The Group agrees as having accepted the terms and conditions of this Group Agreement and any amendments issued during the term of this Group Agreement, upon receipt by KFHPWA of any amount of premium payment. Your Xxxxxx Foundation Health Plan of Washington Evidence of Coverage Xxxxxx Foundation Health Plan of Washington A nonprofit health maintenance organization 2021 Evidence of Coverage CA-2562a21, Important Notice Under Federal Health Care Reform Xxxxxx Foundation Health Plan of Washington (“KFHPWA”) recommends each Member choose a Network Personal Physician. This decision is important since the designated Network Personal Physician provides or arranges for most of the Member’s health care. The Member has the right to designate any Network Personal Physician who participates in one of the KFHPWA networks and who is available to accept the Member or the Member’s family members. For information on how to select a Network Personal Physician, and for a list of the participating Network Personal Physicians, please call Xxxxxx Permanente Member Services at (000) 000-0000 in the Seattle area, or toll-free in Washington, 1-888-901-4636. For children, the Member may designate a pediatrician as the primary care provider. The Member does not need Preauthorization from KFHPWA or from any other person (including a Network Personal Physician) to access obstetrical or gynecological care from a health care professional in the KFHPWA network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining Preauthorization for certain services, following a pre-approved treatment plan, or procedures for obtaining Preauthorization. For a list of participating health care professionals who specialize in obstetrics or gynecology, please call Xxxxxx Permanente Member Services at (000) 000-0000 in the Seattle area, or toll-free in Washington, 1-000-000-0000. Women’s health and cancer rights If the Member is receiving benefits for a covered mastectomy and elects breast reconstruction in connection with the mastectomy, the Member will also receive coverage for: • All stages of reconstruction of the breast on which the mastectomy has been performed. • Surgery and reconstruction of the other breast to produce a symmetrical appearance. • Prostheses. • Treatment of physical complications of all stages of mastectomy, including lymphedemas. These services will be provided in consultation with th...
Acceptance of Group Agreement. The Group agrees as having accepted the terms and conditions of this Group Agreement and any amendments issued during the term of this Group Agreement, upon receipt by KFHPWA of any amount of premium payment.
Acceptance of Group Agreement. Group acknowledges acceptance of the Group Agreement by signing the Group Agreement Face Sheet and returning it to Health Plan. If Group does not return it to Health Plan, Group will be deemed as having accepted this Agreement if Group pays Health Plan any amount toward Premiums. Group may not change the Group Agreement by adding or deleting words, and any such addition or deletion is void. Health Plan might not respond to any changes or comments submitted on or with Group Agreement. Group may not construe Health Plan's lack of response to any submitted changes or comments to imply acceptance. If Group wishes to change anything in the Group Agreement, Group must contact its Health Plan account manager. Health Plan will issue a new Agreement or amendment if Health Plan and Group agree on any changes. Group Authorized Group Representative Please keep this copy with your Agreement. An extra copy of the Signature Page is enclosed for mailing to our California Service Center at P.O. Box 23448, San Diego, CA 92193-3448. Any payment made by Group of amounts owed to Health Plan in accord with the Group Agreement will be deemed to constitute Group’s acceptance of this Agreement. MA_FACE(01-20) - - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - - - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - ✂- - - - - -✂- - - - - -✂- - - - - - Kaiser Foundation Health Plan of the Mid-Atlantic, States, Inc. 0000 Xxxx Xxxxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxx 00000 GROUP AGREEMENT FACE SHEET INTRODUCTION: This Group Agreement consisting of the Group Agreement and Group Evidence of Coverage as supplemented by this Face Sheet, has been entered into between Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., (hereinafter “Health Plan”), and the organization (hereinafter “Group.”) GROUP: DEPT OF EDUCATION GROUP NO.: 009184–2138 COVERAGE: SDT/F4L/W2 /AHF/AL7/A5S/AHF/OA2 AGREEMENT EFFECTIVE DATE: 01/01/2024 OPEN ENROLLMENT PERIOD: Applications made during the Open Enrollment Period from 12/01 to 12/31 provide coverage effective 01/01/2024. MONTHLY PREMIUM: The Group Agreement, Group Evidence of Coverage and Group Face Sheet are executed at the Administrative Offices of Health Plan located in Rockville, Maryland, to take effect as of 01/01/2024.
