Common use of Employment–Related Injuries Clause in Contracts

Employment–Related Injuries. This agreement does NOT cover health care services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  you are self-employed, a sole stockholder of a corporation, or a member of a partnership;  such work-related illnesses, conditions, or injuries were incurred in the course of your self-employment, sole stockholder, or partnership activities; AND  you are not enrolled as an employee under a group health plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional services, you will be deemed to be a subscriber receiving services performed under this agreement.

Employment–Related Injuries. This agreement does NOT cover health care services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  • you are self-employed, a sole stockholder of a corporation, or a member of a partnership;  • such work-related illnesses, conditions, or injuries were incurred in the course of your self-employment, sole stockholder, or partnership activities; AND  • you are not enrolled as an employee under a group health plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional services, you will be deemed to be a subscriber receiving services performed under this agreement.

Employment–Related Injuries. This agreement does NOT cover health care services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  you are self-employed, a sole stockholder of a corporation, or a member of a partnership;  such work-related illnesses, conditions, or injuries were incurred in the course of your self-self- employment, sole stockholder, or partnership activities; AND  you are not enrolled as an employee under a group health plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional services, you will be deemed to be a subscriber receiving services performed under this agreement.

Employment–Related Injuries. This agreement does NOT cover health care dental services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  you are self-employed, a sole stockholder of a corporation, or a member of a partnership;  such work-related illnesses, conditions, or injuries were incurred in the course of your self-employment, sole stockholder, or partnership activities; AND  you are not enrolled as an employee under a group health dental plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care dental services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional servicesdentist, you will be deemed to be a subscriber receiving services performed under this agreement.

Employment–Related Injuries. This agreement does NOT cover health care services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  • you are self-employed, a sole stockholder of a corporation, or a member of a partnership;  • such work-related illnesses, conditions, or injuries were incurred in the course of your self-self- employment, sole stockholder, or partnership activities; AND  • you are not enrolled as an employee under a group health plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional services, you will be deemed to be a subscriber receiving services performed under this agreement.

Employment–Related Injuries. This agreement does NOT cover health care services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  you are (1) self-employed, a sole stockholder of a corporation, or a member of a partnership;  and (2) such work-related illnesses, conditions, or injuries were incurred in the course of your self-employment, sole stockholder, or partnership activities; AND  and (3) you are not enrolled as an employee under a group health plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional services, you will be deemed to be a subscriber receiving services performed under this agreement.

Employment–Related Injuries. This agreement does NOT cover dental and health care services when performed to treat work-related illnesses, conditions, or injuries whether or not you are covered by Workers’ Compensation law, unless;  : • you are self-employed, a sole stockholder of a corporation, or a member of a partnership;  • such work-related illnesses, conditions, or injuries were incurred in the course of your self-self- employment, sole stockholder, or partnership activities; AND  and • you are not enrolled as an employee under a group health plan sponsored by an employer other than the business or partnership described above. However, if your employer is self-insured against Workers’ Compensation liabilities pursuant to a Rhode Island group or individual self-insurance plan for which we provide administrative claims management services, to the extent required by our contract with such plan, we process bills and payments for health care services arising out of work-related illnesses, conditions, or injuries covered by such plan as if the services were covered under this agreement. Although we provide administrative claims management services only, for the purposes of any participating contract between us and (1) a hospital or other health care facility, and (2) a laboratory or any other provider of professional services, you will be deemed to be a subscriber receiving services performed under this agreement.