GUARANTEED RENEWABLE. The Agreement is guaranteed renewable and may be renewed by payment of the premium within thirty-one (31) days after the first day of the month for which payment must be made. Coverage continues for one (1) month from the effective date of the Agreement and from month to month thereafter until terminated in accordance with the Agreement. Non-renewal shall not be based on the deterioration of the mental or physical health of any individual covered under the Agreement.
GUARANTEED RENEWABLE. Upon the payment of the applicable rate, the HMO agrees to make payment for those services as set forth in this Subscriber Agreement. Subject to the right of the HMO to terminate coverage in accordance with Section EL - Eligibility, Change And Termination Rules Under The Plan. This Agreement is guaranteed renewable and may be renewed by payment of renewal Premiums within thirty (30) days after the first day of the month for which payment must be made. Coverage continues for one month from the effective date of the Agreement and from month to month thereafter until terminated as TABLE OF CONTENTS WELCOME 1 How To Contact Us 1 Retail Centers 2 Member Identification (ID) Card 2 SECTION DE - DEFINITIONS 4 SECTION MC - USING THE HMO SYSTEM 16 SECTION CM – CLINICAL MANAGEMENT 18 Utilization Management 18 Care Management 20 Delegation of Utilization Review Activities and Criteria 22 Disease Management Programs 22 Maternity Management Program 22 Quality Management Program 22 Health Education and Wellness Programs 23 How We Evaluate New Technology 23 Alternative Treatment Plans 24 SECTION ACC - ACCESS TO PRIMARY CARE, SPECIALIST AND HOSPITAL CARE NETWORK ........................................................................................................................................................................... 25 Direct Access to Certain Care 25 Selection of a Primary Care Physician 25 How to Obtain a Specialist Referral 25 How to Obtain a Standing Referral 26 Designating a Referred Specialist as a Primary Care Physician 26 Changing Your Primary Care Physician 27 Changing Your Referred Specialist 27 Provider Directory 27 Continuity of Care 27 Preauthorization for Non-Participating Providers 28 Hospital Admissions 28 Recommended Plan of Treatment 29 Member Liability 29 Limitation of the HMO’s Liability 29 Right to Recover Payments Made In Error 30 SECTION ER - EMERGENCY, URGENT CARE, FOLLOW-UP CARE 31 What are Emergency Services 31 What Is Urgent Care? 31 Out-Of-Area Services 32 Emergency Services, Urgent Care and Follow-Up Care Outside Keystone’s Limited NETWORK AREA – The BlueCard Program’s Urgent and Follow-Up Care Benefits 32 Emergency Services, Urgent Care and Follow-Up Care Outside Keystone’s Approved Service Area – The BlueCard Program’s Urgent and Follow-Up Care Benefits 32 Continuing Care 34 SECTION GM - AWAY FROM HOME CARE PROGRAM® GUEST MEMBERSHIP BENEFITS 35 SECTION MR - MEMBERSHIP RIGHTS AND RESPONSIBILITIES 36 Member Rights 36 Member Respo...
GUARANTEED RENEWABLE. Guaranteed renewable means that this contract will renew each year on the anniversary date unless terminated earlier in accordance with contract terms. You may keep this contract in force by timely payment of the required premiums. We may decide not to renew as of the renewal date if: (1) we decide not to renew all contracts issued on this form, with the same type and level of benefits, to residents of the state where you then live; or (2) there is fraud or an intentional material misrepresentation made by or with the knowledge of a member in filing a claim for contract benefits. Rate changes are effective on a member’s annual renewal date and will be based on each member’s attained age, family structure, geographic region, tobacco usage and benefit plan at the time of renewal. We have the right to change premiums. We will notify the member in writing at least 45 days prior to the renewal date of any change in premium rates. If we discontinue offering and decide not to renew all policies issued on this form, with the same type and level of benefits, for all residents of the state where you reside, we will provide a written notice to you at least 90 days prior to the date that we discontinue coverage. At least 45 days advanced written notice of any plan to take an action or make a change permitted by this clause will be delivered to you at your last address as shown in our records. We will make no change in your premium solely because of claims made under this contract or a change in a member's health. While this contract is in force, we will not restrict coverage already in force.
GUARANTEED RENEWABLE. PREMIUM SUBJECT TO CHANGE
GUARANTEED RENEWABLE. Coverage under this Contract is guaranteed renewable at the discretion of the Subscriber, except as permitted to be canceled, rescinded, or not renewed under applicable state and federal law, as described in this Article 14. The Subscriber may renew this Contract at the Subscriber’s option without regard to the health status of the Subscriber or any Covered Person. The Subscriber may renew this Contract by payment of the renewal premium by the end of the applicable Grace Period of the premium due date, provided the following requirements are satisfied:
(1) Eligibility criteria outlined in Article 4 continues to be met.
(2) There are no fraudulent or intentional misrepresentations on the application or under the terms of this Contract.
(3) Coverage has not been terminated by us under the terms of this Contract.
GUARANTEED RENEWABLE. This means You have the right, subject to the terms of this Policy, to continue this Policy as long as You pay the premiums on time. New York Life cannot change any of the terms of this Policy on its own, except that in the future it may increase premiums You pay. We cannot change this Policy without Your consent, unless required by federal or state law, but We may change the premium rates. New York Life has the right to change the premium rates for this Policy. Premium rate increases are subject to Insurance Department approval, will be made only on a Class basis, and will take effect on a Policy Anniversary Date. We will notify You at least 60 days prior to such premium change. Premiums may also change based on any changes that You request to Benefits, as described in the Increase in Benefits and Lower Benefit Plan provisions of the Policy.
GUARANTEED RENEWABLE. This means You have the right, subject to the terms of this Policy, to continue this Policy as long as You pay the premiums on time. New York Life cannot change any of the terms of this Policy on its own, except that in the future it may increase premiums You pay. We cannot change this Policy without Your consent, unless required by federal or state law, but We may change the premium rates. Premium Rate Changes
GUARANTEED RENEWABLE. Coverage under this Agreement is guaranteed renewable except as permitted to be canceled, rescinded, or not renewed under applicable State and federal law, provided the Member is a Qualified Individual as determined by the Exchange. The Member may renew this Agreement by payment of the renewal Premium by the end of the grace period of the Premium due date, provided the following requirements are satisfied:
GUARANTEED RENEWABLE. The annual premium for this rider is shown on the Policy Data page. We can change the premium amount only: (1) After the rider has been in force for three years; and (2) If the change applies to all policies with like benefits insuring the same Risk Class.
GUARANTEED RENEWABLE. PREMIUMS SUBJECT TO CHANGE This Policy is guaranteed renewable for your lifetime or until the Policy’s maximum benefits have been reached. We cannot cancel, refuse to renew or change this Policy as long as you pay the premiums as they become due or within the grace period. We can change the premiums for this Policy at any time and from time to time, and premiums also increase based on your attained age. No change in premium will be effective before the first policy anniversary. Any change will apply to future premiums for all policies with the same form number issued by us to persons in your state of residence. We will give you 31 days notice before any premium change under this provision. Policy Number: 00-00-000000 Monthly N/A $0.00 Effective Date: Jan. 1, 2008 Quarterly $0.00 $0.00 Initial Term Expires: Jan. 1, 2008 Semi Annual $0.00 N/A Initial Premium: $0.00 Annual $0.00 N/A Insured: XXXX XXX Covered Spouse: XXXX XXX Agent RESERVE NATIONAL AGENT Daily Maximum Aggregate Benefit $150.00 Maximum Benefit Period 360 Days Daily Benefit $40.00 Maximum Benefit Period 60 Days EBR-HHC-2 – Extra Benefit Rider Effective Date: Jan. 1, 2008 ANNUAL PHYSICAL EXAMINATION BENEFIT VISION BENEFIT HEARING BENEFIT AMBULANCE BENEFIT IN-HOSPITAL PRIVATE DUTY NURSE BENEFIT PD-2 – Prescription Drug Benefit Rider Effective Date: Jan. 1, 2008 The following terms in this Policy are defined as follows:
