Blue Cross and Blue Shield Responsibilities Sample Clauses

Blue Cross and Blue Shield Responsibilities. For each of the Blue Cross and Blue Shield standard plan design(s) offered to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide you with either a Web site address where you can obtain a copy of the standard Summary of Benefits and Coverage or, upon your request, a copy of the standard Summary of Benefits and Coverage in electronic (PDF) and/or printed format. Access to Summaries of Benefits and Coverage for standard plan designs will be available at least 60 days prior to your coverage effective date or your subsequent renewal date, or within seven business days of your request to Blue Cross and Blue Shield. In the event you have chosen to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide a copy of the Summary of Benefits and Coverage for each customized plan design to you in accordance with the Affordable Care Act and associated regulations. If there are changes that necessitate updating the Summary of Benefits and Coverage after it is provided to you, Blue Cross and Blue Shield will provide the updated Summary of Benefits and Coverage to you within seven business days of the change(s) being identified, but only when the requested changes reflect health care benefits provided by Blue Cross and Blue Shield. Generally, any Summary of Benefits and Coverage provided by Blue Cross and Blue Shield will describe only the health care benefits provided under this Agreement and will not describe health care benefits that are provided by another carrier, organization, or entity. Upon your written request, Blue Cross and Blue Shield will provide printed copies of a Summary of Benefits and Coverage in the number quantities you specify for you to distribute to your eligible employees. Once Blue Cross and Blue Shield has received your confirmation of the benefits as outlined in the Summary of Benefits and Coverage for each of your plan designs, Blue Cross and Blue Shield will provide the requested printed copies to you within seven business days of receiving your written request or your confirmation of the benefits content, whichever is later. Blue Cross and Blue Shield will not provide Summaries of Benefits and Coverage for senior plans (such as Managed Blue for Seniors, Medex, and Medicare Advantage plans) or for any standalone dental and/or vision plans.

Blue Cross and Blue Shield Responsibilities. Blue Cross and Blue Shield will provide a Certificate to Members who are terminated from your Blue Cross and Blue Shield health benefits plans when:  The Member ceases coverage under your health benefits plan and becomes eligible for continued coverage as provided by federal law (COBRA) or, for employers not subject to COBRA, as provided by state law, or coverage would have been lost had the Member not elected to continue coverage under COBRA or state law, provided you promptly notify Blue Cross and Blue Shield of the Member’s loss of coverage.  The Member’s continued coverage ends under COBRA or, for employers not subject to COBRA, under state law, provided you promptly notify Blue Cross and Blue Shield of the Member’s termination.  The terminated Member, or another health care plan or insurance carrier acting on his or her behalf, requests a Certificate, provided the request is received within 24 months of the date he or she terminated coverage under your health benefits plan. In addition, Blue Cross and Blue Shield will provide a Certificate to a Member whose claim is denied because he or she has reached a lifetime limit on all benefits (if any). Blue Cross and Blue Shield will provide a Certificate that specifies the Member’s prior Blue Cross and Blue Shield coverage during the period, up to 18 months, prior to termination as shown on Blue Cross and Blue Shield’s records. This Certificate will not include information as to any waiting period (probationary period) that you may impose on your employees before enrolling them in your health benefits plan. The Certificate will specify that such information is available directly from you. Generally, Blue Cross and Blue Shield will mail all Certificates to the Member’s last known address as shown on Blue Cross and Blue Shield records, both for employees and dependents. Blue Cross and Blue Shield will provide one Certificate in the case of a terminated family membership. However, if different Members under the family membership had different coverages and/or different beginning and ending dates during the 18 months prior to termination, a separate Certificate will be provided for each terminated Member. Blue Cross and Blue Shield will not provide separate Certificates for separate dental or vision care policies (or riders).