Common use of Health Care Benefits Clause in Contracts

Health Care Benefits. Blue Cross and Blue Shield will provide benefits for Members based upon the coverage that is in effect for the Member at the time the services are furnished and on contractual agreements made with providers. No action may be brought against Blue Cross and Blue Shield for failure to provide benefits unless brought within two years from the date the cause of action arises. You will be solely responsible for complying with all applicable provisions of the Employee Retirement Income Security Act of 1974, as amended (ERISA). This includes the fiduciary responsibilities of administering your benefits plans, maintaining adequate funding to support these plans and providing required notices to Members. Solely for the benefits plans provided under this Agreement, and not for purposes of the wellness services and programs described in Attachment 1 or the Account-Based Offerings described in Attachment 2, Blue Cross and Blue Shield is the fiduciary to whom you have granted full discretionary authority to make decisions regarding the amount, form and timing of benefits; to conduct medical necessity review; to apply utilization management; to exercise fair and impartial review of denied claims for services; and to resolve any other matter under the benefits plan which is raised by a Member or identified by Blue Cross and Blue Shield regarding entitlement to benefits as described in the Subscriber Certificates for your benefits plan. All determinations of Blue Cross and Blue Shield with respect to any matter within its assigned responsibility will be conclusive and binding on all persons unless it can be shown that the interpretation or determination was arbitrary and capricious. You agree that all your eligible employees are employed by you or by a subsidiary entirely owned by you. In the event that any such subsidiary is covered by this Agreement, you represent and warrant that you have the authority to enter into this Agreement on behalf of yourself and of every subsidiary that is covered by this Agreement. You, for yourself and for your subsidiaries covered under this Agreement, agree that you and each and every subsidiary are jointly and severally liable for payment of all premium charges owed under this Agreement. In the event that any such subsidiary is sold or is no longer entirely owned by you, you must notify Blue Cross and Blue Shield immediately.

Health Care Benefits. Blue Cross and Blue Shield will provide benefits for Members based upon the coverage that is in effect for the Member at the time the services are furnished and on contractual agreements made with providers. No action may be brought against Blue Cross and Blue Shield for failure to provide benefits unless brought within two years from the date the cause of action arises. You will be solely responsible for complying with all applicable provisions of the Employee Retirement Income Security Act of 1974, as amended (ERISA). This includes the fiduciary responsibilities of administering your benefits plans, maintaining adequate funding to support these plans and providing required notices to Members. Solely for the benefits plans provided under this Agreement, and not for purposes of the wellness health engagement services and programs described in Attachment 1 or the Account-Based Offerings described in Attachment 2, you acknowledge and agree that Blue Cross and Blue Shield is the fiduciary to whom you have granted full discretionary and primary authority to make decisions regarding the amount, form and timing of benefits; to conduct medical necessity review; to apply utilization management; to exercise fair and impartial review of denied claims for services; and to resolve any other matter under the benefits plan which is raised by a Member or identified by Blue Cross and Blue Shield regarding entitlement to benefits as described in the Subscriber Certificates for your benefits plan. All You acknowledge and agree that all determinations of Blue Cross and Blue Shield with respect to any matter within its assigned responsibility will be conclusive and binding on all persons unless it can be shown that the interpretation or determination was arbitrary and capricious. You agree that all your eligible employees are employed by you or by a subsidiary entirely owned by you. In the event that any such subsidiary is covered by this Agreement, you represent and warrant that you have the authority to enter into this Agreement on behalf of yourself and of every subsidiary that is covered by this Agreement. You, for yourself and for your subsidiaries covered under this Agreement, agree that you and each and every subsidiary are jointly and severally liable for payment of all premium charges owed under this Agreement. In the event that any such subsidiary is sold or is no longer entirely owned by you, you must notify Blue Cross and Blue Shield immediately.

Health Care Benefits. Blue Cross and Blue Shield will provide benefits for Members based upon the coverage that is in effect for the Member at the time the services are furnished and on contractual agreements made with providers. No action may be brought against Blue Cross and Blue Shield for failure to provide benefits unless brought within two years from the date the cause of action arises. You will be solely responsible for complying with all applicable provisions of the Employee Retirement Income Security Act of 1974, as amended (ERISA). This includes the fiduciary responsibilities of administering your benefits plans, maintaining adequate funding to support these plans and providing required notices to Members. Solely for the benefits plans provided under this Agreement, and not for purposes of the wellness health engagement services and programs described in Attachment 1 or the Account-Based Offerings described in Attachment 2, Blue Cross and Blue Shield is the fiduciary to whom you have granted full discretionary authority to make decisions regarding the amount, form and timing of benefits; to conduct medical necessity review; to apply utilization management; to exercise fair and impartial review of denied claims for services; and to resolve any other matter under the benefits plan which is raised by a Member or identified by Blue Cross and Blue Shield regarding entitlement to benefits as described in the Subscriber Certificates for your benefits plan. All determinations of Blue Cross and Blue Shield with respect to any matter within its assigned responsibility will be conclusive and binding on all persons unless it can be shown that the interpretation or determination was arbitrary and capricious. You agree that all your eligible employees are employed by you or by a subsidiary entirely owned by you. In the event that any such subsidiary is covered by this Agreement, you represent and warrant that you have the authority to enter into this Agreement on behalf of yourself and of every subsidiary that is covered by this Agreement. You, for yourself and for your subsidiaries covered under this Agreement, agree that you and each and every subsidiary are jointly and severally liable for payment of all premium charges owed under this Agreement. In the event that any such subsidiary is sold or is no longer entirely owned by you, you must notify Blue Cross and Blue Shield immediately.