Exhaustion of Process. The foregoing procedures and process are mandatory and must be exhausted prior to: 1. any investigation of a Complaint or Appeal by the Department of Insurance; or 2. the filing of a Complaint or Appeal with the Department of Insurance; or 3. the establishing of any litigation or arbitration, or any administrative proceeding regarding either any alleged breach of the Group Agreement or Certificate by HMO, or any matter within the scope of the Complaints and Appeals process.
Appears in 5 contracts
Samples: Group Agreement, Certificate of Coverage, Group Agreement
Exhaustion of Process. The foregoing procedures and process are mandatory and must be exhausted prior to:
1. any investigation of a Complaint or Appeal by the Department of Insurance; or
2. the filing of a Complaint or Appeal with the Department of Insurance; or
3. : the establishing of any litigation or arbitration, or any administrative proceeding regarding either any alleged breach of the Group Agreement or Certificate EOC by HMO, or any matter within the scope of the Complaints and Appeals process.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Exhaustion of Process. The foregoing procedures and process are mandatory and must be exhausted prior to:
1. any investigation of a Complaint or Appeal complaint by the Department of Insurance; or
2. the filing of a Complaint or Appeal complaint with the Department of Insurance; or
3. the establishing of any litigation or arbitration, or any administrative proceeding regarding either any alleged breach of the Group Agreement or Certificate by HMO, or any matter within the scope of the Complaints and Appeals processgrievance resolution process of any complaint, grievance or grievance appeal.
Appears in 1 contract
Samples: Group Agreement
Exhaustion of Process. The foregoing procedures and process are mandatory and must be exhausted prior to:
1. any investigation of a Complaint or Appeal by the Department of Insurance; or
2. the filing of a Complaint or Appeal with the Department of Insurance; or
3. to the establishing of any litigation or arbitration, or any administrative proceeding regarding either any alleged breach of the Group Agreement or Certificate by HMO, or any matter within the scope of the Complaints and Appeals process.
Appears in 1 contract
Samples: Group Agreement