Common use of Charges to Members Clause in Contracts

Charges to Members. (a) In no event, including but not limited to nonpayment by Blue Shield or Group, or Blue Shield’s or Group’s insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider), shall Group and Group Providers xxxx, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from or have any recourse against, Members or an individual responsible for their care for Covered Services. Nor shall Group or a Group Provider seek payment from Members or individuals responsible for their care, for payments for Covered Services denied by Blue Shield or Group because such xxxx or claim was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever Blue Shield receives notice of a violation of this Paragraph 8.3, it shall take appropriate action (including without limitation the right to reimburse the Member the amount of any payment and offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group). (b) Group and Group Providers shall not xxxx or collect from a Member any charges in connection with Non-Covered Services, non-Authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, has first obtained a written acknowledgment from the Member that such services are either not Covered Services, not Authorized, or not Medically Necessary, and that the Member, or the Member’s legal representative, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided to the Member and shall be in such form as meets the applicable requirements set forth in the Provider Manual. (c) Group agrees that, in the event of Blue Shield’s insolvency or other cessation of operations, Covered Services to Members will continue through the period for which their premiums have been paid, and Covered Services to Members confined in an inpatient facility on the date of insolvency or other cessation of operations will continue until the Member’s discharge. (d) The provisions of this Paragraph 8.3 shall: (i) survive the termination of this Agreement (and any agreement between Group and Group Provider) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, (ii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.

Charges to Members. (a) In no event, including but not limited to without limitation nonpayment by Blue Shield or GroupShield, or Blue Shield’s or Group’s insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider)Agreement, shall Group and Group Providers xxxxProvider bill, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from from, or have any recourse against, Members a Member, or an any individual responsible for their care such Member’s care, for Covered Services. Nor Without limiting the foregoing, Provider shall Group or a Group Provider not seek payment from Members a Member, or individuals any individual responsible for their such Member’s care, for payments for Covered Services for which payment was denied by Blue Shield or Group because such xxxx the bill or claim for such Covered Services was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever If Blue Shield receives notice of a violation of this Paragraph 8.3Section, it shall have the right to take all appropriate action (action, including without limitation limitation, the right right, following thirty (30) days written notice to Provider, to reimburse the Member for the amount of any payment made and to offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group)Provider. (b) Group and Group Providers Provider shall not xxxx bill or collect from a Member any charges in connection with Non-non- Covered Services, non-Authorized authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, Provider has first obtained a written acknowledgment from the Member Member, or the individual responsible for such Member’s care, that such services are either not Covered Services, not Authorizedauthorized, or not Medically Necessary, as the case may be, and that the Member, or the individual responsible for such Member’s legal representativecare, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided furnished to the Member and shall be in such form as meets satisfy the applicable requirements set forth in the Provider Manual. Notwithstanding the foregoing, if, due to specific circumstances, Provider is not reasonably able to obtain such acknowledgment prior to the time the services are rendered, Provider shall be permitted to seek payment from the Member for such non-Covered Services. (c) Group agrees that, in In the event of Blue Shield’s insolvency or other cessation of operations, Provider shall continue to provide Covered Services to Members will continue through the period for which their such Members’ premiums have been paid, and Covered Services or, with respect to Members enrolled in Blue Shield’s Medicare Advantage Benefit Program, the duration of the contract period for which the Centers for Medicare and Medicaid Services (“CMS”) payments have been made, and, with respect to any Member who is confined in an inpatient facility on the date of insolvency or other cessation of operations will continue operations, until the Member’s discharge. (d) The provisions of this Paragraph 8.3 Section 3.5 shall: (i) survive the expiration or termination for any reason of this Agreement Agreement; (and any agreement between Group and Group Providerii) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, , (iiiii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the any Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.

Charges to Members. (a) In no event, including but not limited to without limitation nonpayment by Blue Shield or GroupHealth Plan, or Blue Shield’s or GroupHealth Plan’s insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider)Agreement, shall Group and Group Providers xxxxProvider bill, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from from, or have any recourse against, Members a Member, or an any individual responsible for their care such Member’s care, for Covered Services. Nor Without limiting the foregoing, Provider shall Group or a Group Provider not seek payment from Members a Member, or individuals any individual responsible for their such Member’s care, for payments for Covered Services for which payment was denied by Blue Shield or Group Health Plan because such xxxx the bill or claim for such Covered Services was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever Blue Shield If Health Plan receives notice of a violation of this Paragraph 8.3Section, it shall have the right to take all appropriate action (action, including without limitation limitation, the right right, following thirty (30) days’ written notice to Provider, to reimburse the Member for the amount of any payment made and to offset the amount of such payment from any amounts then or thereafter owed by Blue Shield Health Plan to Group)Provider. (b) Group and Group Providers Provider shall not xxxx bill or collect from a Member any charges in connection with Non-non- Covered Services, non-Authorized authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, Provider has first obtained a written acknowledgment from the Member Member, or the individual responsible for such Member’s care, that such services are either not Covered Services, not Authorizedauthorized, or not Medically Necessary, as the case may be, and that the Member, or the individual responsible for such Member’s legal representativecare, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided furnished to the Member and shall be in such form as meets satisfy the applicable requirements set forth in the Provider Manual. Notwithstanding the foregoing, if, due to specific circumstances, Provider is not reasonably able to obtain such acknowledgment prior to the time the services are rendered, Provider shall be permitted to seek payment from the Member for such non-Covered Services. (c) Group agrees that, in In the event of Blue ShieldHealth Plan’s insolvency or other cessation of operations, Provider shall continue to provide Covered Services to Members will continue through the period for which their such Members’ premiums have been paid, and Covered Services or, with respect to Members enrolled in Health Plan’s Medicare Advantage Benefit Program, the duration of the contract period for which the CMS payments have been made, and, with respect to any Member who is confined in an inpatient facility on the date of insolvency or other cessation of operations will continue operations, until the Member’s discharge. (d) The provisions of this Paragraph 8.3 Section 3.5 shall: (i) survive the expiration or termination for any reason of this Agreement Agreement; (and any agreement between Group and Group Providerii) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, (ii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.,

Charges to Members. (a) In no event, including but not limited to without limitation nonpayment by Blue Shield or GroupShield, or Blue Shield’s or Group’s insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider)Agreement, shall Group and Group Providers xxxxProvider bill, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from from, or have any recourse against, Members a Member, or an any individual responsible for their care such Member’s care, for Covered Services. Nor Without limiting the foregoing, Provider shall Group or a Group Provider not seek payment from Members a Member, or individuals any individual responsible for their such Member’s care, for payments for Covered Services for which payment was denied by Blue Shield or Group because such xxxx the bill or claim for such Covered Services was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever If Blue Shield receives notice of a violation of this Paragraph 8.3Section, it shall have the right to take all appropriate action (action, including without limitation limitation, the right right, following thirty (30) days written notice to Provider, to reimburse the Member for the amount of any payment made and to offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group)Provider. (b) Group and Group Providers Provider shall not xxxx bill or collect from a Member any charges in connection with Nonnon-Covered Services, non-Authorized authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, Provider has first obtained a written acknowledgment from the Member Member, or the individual responsible for such Member’s care, that such services are either not Covered Services, not Authorizedauthorized, or not Medically Necessary, as the case may be, and that the Member, or the individual responsible for such Member’s legal representativecare, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided furnished to the Member and shall be in such form as meets satisfy the applicable requirements set forth in the Provider Manual. Notwithstanding the foregoing, if, due to specific circumstances, Provider is not reasonably able to obtain such acknowledgment prior to the time the services are rendered, Provider shall be permitted to seek payment from the Member for such non-Covered Services. (c) Group agrees that, in In the event of Blue Shield’s insolvency or other cessation of operations, Provider shall continue to provide Covered Services to Members will continue through the period for which their such Members’ premiums have been paid, and Covered Services or, with respect to Members enrolled in Blue Shield’s Medicare Advantage Benefit Program, the duration of the contract period for which the Centers for Medicare and Medicaid Services (“CMS”) payments have been made, and, with respect to any Member who is confined in an inpatient facility on the date of insolvency or other cessation of operations will continue operations, until the Member’s discharge. (d) The provisions of this Paragraph 8.3 Section 3.5 shall: (i) survive the expiration or termination for any reason of this Agreement Agreement; (and any agreement between Group and Group Providerii) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, (iiiii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the any Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.

Charges to Members. (a) In no event, including but not limited to without limitation nonpayment by Blue Shield or GroupShield, or Blue Shield’s or Group’s insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider)Agreement, shall Group and Group Providers xxxxProvider bill, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from from, or have any recourse against, Members a Member, or an any individual responsible for their care such Member’s care, for Covered Services. Nor Without limiting the foregoing, Provider shall Group or a Group Provider not seek payment from Members a Member, or individuals any individual responsible for their such Member’s care, for payments for Covered Services for which payment was denied by Blue Shield or Group because such xxxx the bill or claim for such Covered Services was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever If Blue Shield receives notice of a violation of this Paragraph 8.3Section, it shall have the right to take all appropriate action (action, including without limitation limitation, the right right, following thirty (30) days written notice to Provider, to reimburse the Member for the amount of any payment made and to offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group)Provider. (b) Group and Group Providers Provider shall not xxxx bill or collect from a Member any charges in connection with Non-non- Covered Services, non-Authorized authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, Provider has first obtained a written acknowledgment from the Member Member, or the individual responsible for such Member’s care, that such services are either not Covered Services, not Authorizedauthorized, or not Medically Necessary, as the case may be, and that the Member, or the individual responsible for such Member’s legal representativecare, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided furnished to the Member and shall be in such form as meets satisfy the applicable requirements set forth in the Provider Manual. Notwithstanding the foregoing, if, due to specific circumstances, Provider is not reasonably able to obtain such acknowledgment prior to the time the services are rendered, Provider shall be permitted to seek payment from the Member for such non-Covered Services. (c) Group agrees that, in In the event of Blue Shield’s insolvency or other cessation of operations, Provider shall continue to provide Covered Services to Members will continue through the period for which their such Members’ premiums have been paid, and Covered Services or, with respect to Members enrolled in Blue Shield’s Medicare Advantage Benefit Program, the duration of the contract period for which the Centers for Medicare and Medicaid Services (“CMS”) payments have been made, and, with respect to any Member who is confined in an inpatient facility on the date of insolvency or other cessation of operations will continue operations, until the Member’s discharge. (d) The provisions of this Paragraph 8.3 Section 3.5 shall: (i) survive the expiration or termination for any reason of this Agreement Agreement; (and any agreement between Group and Group Providerii) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, (ii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.,

Charges to Members. (a) In no event, including but not limited to without limitation nonpayment by Blue Shield or GroupShield, or Blue Shield’s or Group’s insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider)Agreement, shall Group and Group Providers Provider xxxx, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from from, or have any recourse against, Members a Member, or an any individual responsible for their care such Member’s care, for Covered Services. Nor Without limiting the foregoing, Provider shall Group or a Group Provider not seek payment from Members a Member, or individuals any individual responsible for their such Member’s care, for payments for Covered Services for which payment was denied by Blue Shield or Group because such the xxxx or claim for such Covered Services was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever If Blue Shield receives notice of a violation of this Paragraph 8.3Section, it shall have the right to take all appropriate action (action, including without limitation limitation, the right right, following thirty (30) days written notice to Provider, to reimburse the Member for the amount of any payment made and to offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group)Provider. (b) Group and Group Providers Provider shall not xxxx or collect from a Member any charges in connection with Non-non- Covered Services, non-Authorized authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, Provider has first obtained a written acknowledgment from the Member Member, or the individual responsible for such Member’s care, that such services are either not Covered Services, not Authorizedauthorized, or not Medically Necessary, as the case may be, and that the Member, or the individual responsible for such Member’s legal representativecare, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided furnished to the Member and shall be in such form as meets satisfy the applicable requirements set forth in the Provider Manual. Notwithstanding the foregoing, if, due to specific circumstances, Provider is not reasonably able to obtain such acknowledgment prior to the time the services are rendered, Provider shall be permitted to seek payment from the Member for such non-Covered Services. (c) Group agrees that, in In the event of Blue Shield’s insolvency or other cessation of operations, Provider shall continue to provide Covered Services to Members will continue through the period for which their such Members’ premiums have been paid, and Covered Services or, with respect to Members enrolled in Blue Shield’s Medicare Advantage Benefit Program, the duration of the contract period for which the Centers for Medicare and Medicaid Services (“CMS”) payments have been made, and, with respect to any Member who is confined in an inpatient facility on the date of insolvency or other cessation of operations will continue operations, until the Member’s discharge. (d) The provisions of this Paragraph 8.3 Section 3.5 shall: (i) survive the expiration or termination for any reason of this Agreement Agreement; (and any agreement between Group and Group Providerii) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, (ii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.,

Charges to Members. (a) In no event, including but not limited to nonpayment by Blue Shield or Group, or Blue Shield’s or Group’s insolvency or breach breath of this Agreement (or breach by Group of its agreement with Group Provider), shall Group and Group Providers xxxxbxxx, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from or have any recourse against, . Members or an individual responsible for their care for Covered Services. Nor shall Group or a Group Provider seek payment from Members or individuals responsible for their care, for payments for Covered Services denied by Blue Shield or Group because such xxxx bxxx or claim was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. , Whenever Blue Shield receives notice of a violation of this Paragraph 8.3, it shall take appropriate action (including without limitation the right to reimburse the Member the amount of any payment and offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group). (b) Group and Group Providers shall not xxxx bxxx or collect from a Member any charges in connection with Non-Covered Services, non-Authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, has first obtained a written acknowledgment from the Member that such services are either not Covered Services, not Authorized, or not Medically Necessary, and that the Member, or the Member’s legal representative, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided to the Member and shall be in such form as meets the applicable requirements set forth in the Provider Manual. (c) Group agrees that, in the event of Blue Shield’s insolvency or other cessation of operations, Covered Services to Members will continue through the period for which their premiums have been paid, and Covered Services to Members confined in an inpatient facility on the date of insolvency or other cessation of operations will continue until the Member’s discharge. (d) The provisions of this Paragraph 8.3 shall: (i) survive the termination of this Agreement (and any agreement between Group and Group Provider) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, (ii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.

Charges to Members. (a) In no event, including but not limited to without limitation nonpayment by Blue Shield or GroupShield, or Blue Shield’s or Group’s 's insolvency or breach of this Agreement (or breach by Group of its agreement with Group Provider)Agreement, shall Group and Group Providers xxxxProvider bill, charge, collect a deposit from, impose a surcharge on, seek compensation, remuneration or reimbursement from from, or have any recourse against, Members a Member, or an any individual responsible for their care such Member’s care, for Covered Services. Nor Without limiting the foregoing, Provider shall Group or a Group Provider not seek payment from Members a Member, or individuals any individual responsible for their such Member’s care, for payments for Covered Services for which payment was denied by Blue Shield or Group because such xxxx the bill or claim for such Covered Services was not timely or properly submitted, or because the rendered services were not Medically Necessary or Authorized. Whenever If Blue Shield receives notice of a violation of this Paragraph 8.3Section, it shall have the right to take all appropriate action (action, including without limitation limitation, the right right, following thirty (30) days’ written notice to Provider, to reimburse the Member for the amount of any payment made and to offset the amount of such payment from any amounts then or thereafter owed by Blue Shield to Group)Provider. (b) Group and Group Providers Provider shall not xxxx bill or collect from a Member any charges in connection with Non-non- Covered Services, non-Authorized authorized services, or services determined not to be Medically Necessary unless Group, or as applicable, the Group Provider, Provider has first obtained a written acknowledgment from the Member Member, or the individual responsible for such Member’s care, that such services are either not Covered Services, not Authorizedauthorized, or not Medically Necessary, as the case may be, and that the Member, or the individual responsible for such Member’s legal representativecare, is financially responsible for the cost of such services. Such acknowledgment shall be obtained prior to the time that such services are provided furnished to the Member and shall be in such form as meets satisfy the applicable requirements set forth in the Provider Manual. Notwithstanding the foregoing, if, due to specific circumstances, Provider is not reasonably able to obtain such acknowledgment prior to the time the services are rendered, Provider shall be permitted to seek payment from the Member for such non-Covered Services. (c) Group agrees that, in In the event of Blue Shield’s 's insolvency or other cessation of operations, Provider shall continue to provide Covered Services to Members will continue through the period for which their such Members’ premiums have been paid, and Covered Services or, with respect to Members enrolled in Blue Shield’s Medicare Advantage Benefit Program, the duration of the contract period for which the Centers for Medicare and Medicaid Services (“CMS”) payments have been made and, with respect to any Member who is confined in an inpatient facility on the date of insolvency or other cessation of operations will continue operations, until the Member’s 's discharge. (d) The provisions of this Paragraph 8.3 Section 3.5 shall: (i) survive the expiration or termination for any reason of this Agreement Agreement; (and any agreement between Group and Group Providerii) regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and, , (iiiii) supersede any oral or written contrary agreement (now existing or hereafter entered into) between the Group or Group Provider and the any Member. (e) The provisions of this Paragraph 8.3 shall be incorporated into any agreement between the Group and its contracted healthcare providers. This Paragraph 8.3 shall not be changed without the prior approval of the appropriate government regulatory agency.