Common use of Failure to Cooperate Clause in Contracts

Failure to Cooperate. The [Member] fails to assist Us in coordinating benefits as described in the Coordination of Benefits and Services Section. If We give the [Member] such written notice: a) that person will cease to be a [Member] for the coverage under this Contract immediately if termination is occurring due to Misuse of Identification Card (b above) or Misconduct (e above), otherwise, on the date 31 days after such written notice is given by Us; and b) no benefits will be provided to the [Member] under the coverage after that date. Any action by Us under these provisions is subject to review in accordance with the Appeal Procedures We establish. A [Member's] Primary Care Provider provides basic health maintenance services and coordinates a [Member's] overall health care. Anytime a [Member] needs medical care, the [Member] should contact his or her Primary Care Provider and identify himself or herself as a [Member] of this program. In an Emergency, a [Member] may go directly to the emergency room. If a [Member] does, then the [Member] must call his or her Primary Care Provider [or the Care Manager] and [Member] Services within 48 hours. If a [Member] does not call within 48 hours, We will provide services only if We Determine that notice was given as soon as was reasonably possible.

Failure to Cooperate. The [Member] fails to assist Us in coordinating benefits as described in the Coordination of Benefits and Services Section. If We give the [Member] such written notice: a) that person will cease to be a [Member] for the coverage under this Contract immediately if termination is occurring due to Misuse of Identification Card (b above) or Misconduct (e above), otherwise, on the date 31 days after such written notice is given by Us; and b) no benefits will be provided to the [Member] under the coverage after that date. Any action by Us under these provisions is subject to review in accordance with the Appeal Procedures We establish. A [Member's] Primary Care Provider Physician provides basic health maintenance services and coordinates a [Member's] overall health care. Anytime a [Member] needs medical care, the [Member] should contact his or her Primary Care Provider Physician and identify himself or herself as a [Member] of this program. In an Emergency, a [Member] may go directly to the emergency room. If a [Member] does, then the [Member] must call his or her Primary Care Provider Physician [or the Care Manager] and [Member] Services within 48 hours. If a [Member] does not call within 48 hours, We will provide services only if We Determine that notice was given as soon as was reasonably possible.