Compensation Benefits. Any sickness or injury for which the Member is paid benefits, or may be paid benefits if claimed, if the Member is covered or could be covered by Workers' Compensation. In addition, if the Member enters into a settlement giving up rights to recover past or future medical benefits under a Workers’ Compensation law, AvMed will not cover past or future Health Care Services that are the subject of or related to that settlement. Furthermore, if the Member is covered by a Worker’s Compensation program that limits benefits if other than specified Health Care Providers are used and the Member receives care or services from a Health Care Provider not specified by the program, AvMed will not cover the balance of any costs remaining after the program has paid.
Appears in 28 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract
Compensation Benefits. Any sickness or injury for which the Member is paid benefits, or may be paid benefits if claimed, if the Member is covered or could be covered by Workers' Compensation. In addition, if the Member enters into a settlement giving up rights to recover past or future medical benefits under a Workers’ Compensation law, AvMed will not cover past or future Health Care Services that are the subject of or related to that settlement. Furthermore, if the Member is covered by a Worker’s Compensation program that limits benefits if other than specified Health Care Providers are used and the Member receives care or services from a Health Care Provider not specified by the program, AvMed will not cover the balance of any costs remaining after the program has paid.paid.
Appears in 9 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract
Compensation Benefits. Any sickness or injury for which the Member is paid benefits, benefits or may be paid benefits if claimed, if the Member is covered or could required to be covered by Workers' Compensation. In addition, if the Member enters into a settlement giving up rights to recover past or future medical benefits under a Workers’ Compensation law, AvMed will shall not cover past or future Health Care Services that are the subject of or related to that settlement. Furthermore, if the Member is covered by a Worker’s Compensation program that limits benefits if other than specified Health Care Providers are used and the Member receives care or services from a Health Care Provider not specified by the program, AvMed will shall not cover the balance of any costs remaining after the program has paid.
Appears in 7 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract
Compensation Benefits. Any sickness or injury for which the Member is paid benefits, or may be paid benefits if claimed, if the Member is covered or could be covered by Workers' Compensation. In addition, if the Member enters into a settlement giving up rights to recover past or future medical benefits under a Workers’ Compensation law, AvMed will not cover past or future Health Care Services that are the subject of or related to that settlement. Furthermore, if the Member is covered by a Worker’s Compensation program that limits benefits if other than specified Health Care Providers are used and the Member receives care or services from a Health Care Provider not specified by the program, AvMed will not cover the balance of any costs remaining after the program has paid.
XII. PRESCRIPTION MEDICATION BENEFITS, LIMITATIONS AND EXCLUSIONS
Appears in 2 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract
Compensation Benefits. Any sickness or injury for which the Member is paid benefits, or may be paid benefits if claimed, if the Member is covered or could required to be covered by Workers' Compensation. In addition, if the Member enters into a settlement giving up rights to recover past or future medical benefits under a Workers’ Compensation law, AvMed will shall not cover past or future Health Care Services that are the subject of or related to that settlement. Furthermore, if the Member is covered by a Worker’s Compensation program that limits benefits if other than specified Health Care Providers are used and the Member receives care or services from a Health Care Provider not specified by the program, AvMed will shall not cover the balance of any costs remaining after the program has paid.
Appears in 1 contract
Samples: Large Group Hmo Plan Medical and Hospital Service Contract