Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Procedure in this Certificate.
Appears in 8 contracts
Samples: Certificate of Coverage, Certificate of Coverage, Certificate of Coverage
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Procedure Claim Procedures/Complaints and Appeals/Dispute Resolution procedure set forth in the Claim Procedures/Complaints and Appeals /Dispute Resolution section of this Certificate.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate EOC is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this CertificateEOC, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this CertificateEOC. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this CertificateEOC, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate EOC have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate EOC shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate EOC shall be terminated immediately, subject to the Grievance Procedure Complaint procedure set forth in the Complaints and Appeals/Independent Medical Review sections of this CertificateEOC.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered DependentsMember, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Complaint Procedure set forth in the Claim Determination Procedures/Complaints and Appeals section of this Certificate.
Appears in 1 contract
Samples: Group Agreement
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Procedure Administrative Complaints section in this Certificate.
Appears in 1 contract
Samples: Group Agreement
Identification Card. The identification card Identification Card issued by HMO to Members pursuant to this Certificate Contract is for identification purposes only. Possession of an HMO identification card Identification Card confers no right to services or benefits under this CertificateContract, and misuse of such identification card may be grounds for termination of Member’s 's coverage pursuant to the Termination of Coverage section Section VII.F of this CertificateContract. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered DependentsSubscriber's Dependents who are Members. To be eligible for services or benefits under this CertificateContract, the holder of the card must be a Member on whose behalf all applicable Premium premium charges under this Certificate Contract have been paid. Any person receiving services or benefits which such person he or she is not entitled to receive pursuant to the provisions of this Certificate Contract shall be charged for such services or benefits at billed chargesprevailing rates. If any Member permits the use of the Member’s his or her HMO identification card Identification Card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered his or her Dependents, if any, pursuant to this Certificate Contract shall be terminated immediately, subject to the Grievance Procedure set forth in Section IX.M of this CertificateContract.
Appears in 1 contract
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Procedure Claim Procedures/Complaints and Appeals in this Certificate.
Appears in 1 contract
Samples: Group Agreement
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Procedure Claim Procedures/Complaints and Appeals, External Review Procedures in this Certificate.
Appears in 1 contract
Samples: Group Agreement
Identification Card. The identification card issued by HMO to Members pursuant to this Certificate is for identification purposes only. Possession of an HMO identification card confers no right to services or benefits under this Certificate, and misuse of such identification card may be grounds for termination of Member’s coverage pursuant to the Termination of Coverage section of this Certificate. If the Member who misuses the card is the Subscriber, coverage may be terminated for the Subscriber as well as any of the Covered Dependents. To be eligible for services or benefits under this Certificate, the holder of the card must be a Member on whose behalf all applicable Premium charges under this Certificate have been paid. Any person receiving services or benefits which such person is not entitled to receive pursuant to the provisions of this Certificate shall be charged for such services or benefits at billed charges. If any Member permits the use of the Member’s HMO identification card by any other person, such card may be retained by HMO, and all rights of such Member and their Covered Dependents, if any, pursuant to this Certificate shall be terminated immediately, subject to the Grievance Procedure set forth in the Grievance Procedure section of this Certificate.
Appears in 1 contract
Samples: Group Agreement