Keep Your Plan Informed of Address Changes. In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Keep Your Plan Informed of Address Changes. In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. PLAN CONTACT INFORMATION Contact your employer for the name, address and telephone number of the party responsible for administering your COBRA continuation coverage. This group health plan believes this plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to your Employer or the Plan Administrator. If your health plan is subject to the Employee Retirement Income Security Act (ERISA),you may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 0-000-000-0000 or xxx.xxx.xxx/xxxx/xxxxxxxxxxxx. This website has a table summarizing which protections do and do not apply to grandfathered health plans. For non- federal governmental plans, inquires may be directed to the U.S. Department of Health and Human Services at xxx.xxxxxxxxxxxx.xxx. ALTHOUGH HEALTH CARE SERVICES MAY BE OR HAVE BEEN PROVIDED TO YOU AT A HEALTH CARE FACILITY THAT IS A MEMBER OF THE PROVIDER NETWORK USED BY YOUR HEALTH BENEFIT PLAN, OTHER PROFESSIONAL SERVICES MAY BE OR HAVE BEEN PROVIDED AT OR THROUGH THE FACILITY BY PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS WHO ARE NOT MEMBERS OF THAT NETWORK. YOU MAY BE RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR THOSE PROFESSIONAL SERVICES THAT ARE NOT PAID OR COVERED BY YOUR HEALTH BENEFIT PLAN. This notice is to advise you of certain coverage/benefits provided by your contract with Blue Cross and Blue Shield of Texas (H...
Keep Your Plan Informed of Address Changes. In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. PLAN CONTACT INFORMATION Contact your employer for the name, address and telephone number of the party responsible for administering your COBRA continuation coverage. This Notice is to advise You that in addition to the processes outlined in COMPLAINT AND APPEAL PROCEDURES section of the Certificate and in the Plan Description and Member Handbook, you have the right to seek and obtain a full and fair review by HMO of any Adverse Benefit Determinations made by HMO in accordance with the benefits and procedures detailed in Your Certificate. Review of Claim Determinations Claim Determinations. When HMO receives a properly submitted claim, it has authority and discretion under the plan to interpret and determine benefits in accordance with the plan provisions. You have the right to seek and obtain a full and fair review by HMO of any determination of a claim, any determination of a request for preauthorization, or any other determination made by HMO in accordance with the benefits and procedures detailed in Your plan. If a Claim is Denied or Not Paid in Full. If the claim is denied in whole or in part, You will receive a written notice from HMO with the following information, if applicable: • The reasons for the determination; • A reference to the benefit Plan provisions on which the determination is based, or the contractual, administrative or protocol basis for the determination; • A description of additional information which may be necessary to perfect the claim and an explanation of why such material is necessary; • Subject to privacy laws and other restrictions, if any, the identification of the claim, date of service, health care provider, claim amount (if applicable), and a statement describing denial codes with their meanings and the standards used. Upon request, diagnosis/treatment codes with their meanings and the standards used are also available; • An explanation of HMO’s internal review/appeals and external review processes (and how to initiate a review/appeal or external review) and a statement of Your right, if any, to bring a civil action under Section 502(a) of ERISA following a final denial on internal review/appeal; • In certain situations, a statement in non-English language(s) that written notice of clai...
Keep Your Plan Informed of Address Changes. In order to protect your family’s rights, you should keep your university human resources office informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to your university human resources office. Any notification, which is your responsibility under law, will not be considered adequate unless it is made to the human resources office. *Under Federal law a “legal separation” is a qualifying event if it causes loss of coverage. For Pennsylvania residents, there is no “legal separation” recognized in the law. Therefore, separation would not be a qualifying event entitling the spouse and children to COBRA coverage. The “qualifying event” is the date of the divorce since separation is not recognized in Pennsylvania.
