Insurance Coverage Changes. If an employee wishes to make any change to their health insurance coverage such as an addition of a dependent, deletion of a dependent, etc. the Employer must be notified, in writing within three (3) weeks of the occurrence. If the notice of the addition of dependents is not made within the three (3) week period, the addition will not be able to be effective until the next open enrollment period, which is January 1 of every year.
Insurance Coverage Changes. If an employee wishes to make any change to their insurance coverage such as an addition of a dependent, deletion of a dependent, etc., the County must be notified in writing, within three (3) weeks of the occurrence. If notice of the addition of dependents is not made within the three (3) week period, the addition will not be able to be effective until the next open enrollment period. The open enrollment period is the 30-day period prior to January 1st of each year.
Insurance Coverage Changes. 1. Effective July 1, 2003, Capital City Press ancillary coverage (Life, AD&D and LTD) changed from Hartford and Fortis (administered by CBA) to Reliance Standard Insurance Co.
Insurance Coverage Changes. If your insurance coverage changes, please provide a copy of both the front and back of your new insurance card so we can update your record. Failure to inform us of your new insurance information in a timely manner may result in a denial of your claim by your insurance carrier. In this case, the patient may be responsible for 100% of the allowable charges. MINORS Minor Patients: The parent(s)/guardian(s) accompanying a minor is/are responsible for full payment. SURGERIES/PROCEDURES For scheduled surgeries or procedures, a $25 deposit will be collected to hold your procedure date. The deposit will be applied to any patient financial responsibility owed for the procedure. If the balance due is less than the deposit, the remaining balance will be refunded to the patient after insurance payments have been collected. For failure to cancel within five (5) business days of the procedure date, a $50 cancellation fee (forfeiture of your deposit and additional charges) will be applicable. AUTOMATIC PAYMENT POLICY Xxxx X Xxxxxx MD has an automatic payment policy. We require our patients to keep a credit or debit card on file in our Vault with Rectangle Health. With your consent, we will charge this card any balances due, including, but not limited to co-payments, co-insurances, and deductibles. Payment will be run on the morning of your appointment. If you “No show” or cancel your appointment with less than 24 hours notice/one (1) business day, a fee of $50 will be charged to your card less the amount of balances billed for the visit. This policy applies to in-office visits, telemedicine appointments, and procedure/surgery appointments. The vault system we use through Rectangle Health is secure, encrypted, and HIPAA compliant. Once entered, only the last four (4) digits of your card are viewable. For charges over $100.00, you will be notified prior to processing payment. By signing below: I authorize Xxxx X Xxxxxx MD to keep my credit card information on file and to charge my card for the balance of charges not paid within 30 days of remittance of my billing statement, in addition to any additional fees, including the no show/cancellation fee of $50. For planned surgeries or procedures, I authorize Xxxx X Xxxxxx MD to charge my card on file a $25 deposit to hold my procedure/surgery date, which will be forfeited if I No show/cancel with less than 5 business days notice. I assign my insurance benefits to the Xxxx X Xxxxxx MD listed above. I understand that this form ...
