Claims Provisions. This Section tells you how and when to file a claim under the Plan.
Claims Provisions. The following provisions shall apply in respect of each Claim:
Claims Provisions. All benefits will be paid in United States dollars. The following provisions apply to all benefits. NOTICE OF CLAIM: Written notice of claim must be given by either you or someone acting on your behalf (herein referred to as the “Claimant”) to our designated representative or us within 30 days after a covered reason first begins or as soon as reasonably possible. Notice must include your name and the policy number.
Claims Provisions. When a Member receives Authorized Benefits and Services from an Affiliated Provider, Member will not be required to pay any amounts except for applicable Co-Pays, Deductibles and Coinsurance. Member will not be required to submit any claim forms for Authorized Benefits and Services received from Affiliated Providers. Member is responsible for the cost of any services received from non-Affiliated Providers or Physicians unless those services were arranged for and approved in advance by your Affiliated Physician and the Plan, or unless they were the result of treatment for a Medical Emergency. Members will receive an Explanation of Benefits from the Plan and the Provider of Services will receive an Explanation of Payment upon filing a Clean Claim with the Plan. Plan pays Clean Claims that are submitted within one year from the date of service within forty-five (45) days of receipt. Member Self Pay. If a Member is required to pay for an Authorized Benefit and Services (other than for applicable Deductible, Coinsurance or Co-Pay), a written request for reimbursement can be made to the Plan. The request must include a bill that shows exactly what services were received, including applicable diagnosis and CPT codes, the date, place of service and rendering provider. A statement that shows only the amount owed is not sufficient. Reimbursement will be made less any applicable Co-pay, Coinsurance and Deductible. If you have questions about what is required, call Total Health Care, USA Customer Service Department at (000) 000-0000. Reimbursement Request Time Limit. Request for reimbursement for a self-pay Authorized Benefit and Service must be made within sixty (60) days of the date in which the services were obtained. Requests for reimbursement beyond the sixty (60) days can be limited or refused by the Plan, unless it is not reasonably possible to provide proof of payment in the required time. The required information must be made available as soon as reasonably possible. Upon review of the request for reimbursement, the Plan may require additional information to process a reimbursement request. Unless Member is legally incapacitated and, therefore, unable to respond, the Plan will not be liable for a claim or reimbursement request if additional information is not received within sixty (60) days of the request. The Plan’s right to that information or documentation may be limited by state or federal law. The Plan will be liable for a claim or reimbursement request ...
Claims Provisions. Subject to the provisions of Section 11.4, upon the Company or any of the subsidiaries becoming aware of any claim being made against the Company or any of the subsidiaries in respect of a Tax liability which may give rise to a liability for the Sellers to pay Tax under Section 13.3 or 13.4, the Buyer shall procure that the Company or that subsidiary will as soon as reasonably practicable give notice of the claim to each of the Sellers and the Buyer shall procure that the Company or that subsidiary will take such reasonable action and give such reasonable information and assistance in connection with the affairs of the Company or that subsidiary as may be both reasonably requested in writing by the Sellers and reasonably necessary to avoid, resist, object to, appeal or compromise the claim.
Claims Provisions. 1. On the happening of any occurrence likely to give rise to a Claim under this Group Policy notice shall be given to The Claims Service Team as soon as reasonably possible after the date of the occurrence.
Claims Provisions. 9.1 Notice of Claim 9.2 Proof of Loss 9.3 Payment of Claims 9.4 Appeals 9.5 Claim Overpayment 9.6 Independent Third Party Review
Claims Provisions. Notice of Claim Proof of Claim Payment of Claims Assignment Co-ordinating Coverage Guidelines for Health Care Expenses Co-ordination of Benefits Recovering Overpayments Third Party Claim Recovery Legal Action Rights of Liberty Health and The Claimant Converting Group Coverage to an Individual Insurance Policy Extended Health Care and Dental Care Coverage Long Term Disability Coverage Extended Health Care Coverage Dental Care Coverage IMP CLAIM CONVERT DENTAL IMPORTANT INFORMATION COVERED CLASS: All Eligible Unionized Employees GROUP NUMBERS: Hourly-Paid Employees Office Employees PLAN EFFECTIVE DATE: May The Summary of Coverages and the pages following give you a full description of all the conditions, limitations and exclusions that apply to your coverage. Be sure to read this information carefully and keep it in a safe place for future reference. EDITION DATE June, SUMMARY OF COVERAGES FOR YOU LONG TERM DISABILITY COVERAGE Monthly of your monthly Earnings as of the beginning of your Total Disability (rounded to the next higher multiple of if not already a multiple thereof) up to a maximum of If you are entitled to benefits from certain other sources during your Total Disability, the amount of Monthly Benefit may be reduced as explained in the Integration of Benefits section of the Long Term Coverage.
Claims Provisions. A. A written claim must be filed by the Customer within 2 days of delivery of the shipment to the final destination. In case of failure to make delivery, then a written claim must be filed by the Customer within 2 days after a reasonable time for delivery has elapsed.
Claims Provisions. Basis of Valuation – The total sum insured for a claim under this Certificate shall be the estimated amount for which the Pens & Jetties should exchange immediately before the damage, between a willing buyer and a willing seller in an arms length transaction, after proper marketing wherein the parties had each acted knowledgeably, prudently and without compulsion.
