Common use of Blue Cross and Blue Shield Responsibilities Clause in Contracts

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).