Common use of Liability of Plan Affiliates Clause in Contracts

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLAF MLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate at the end of the billing period in which the leave of absence period expires, or as otherwise described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage c overage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. 1. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time full -time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for for 2. When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. 3. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-Pre- existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate at the end of the billing period in which the leave of absence period expires, or as otherwise described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the t he Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time full -time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate at the end of the billing period in which the leave of absence period expires, or as otherwise described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible eligibl e and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to t o be entitled to continued coverage under this Plan. 1. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate at the end of the billing period in which the leave of absence period expires, or as otherwise described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. 2. When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Planwill 3. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The Group, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan constitutes a contract solely between the Group and Blue Cross and Blue Shield of Louisiana, that Blue Cross and Blue Shield of Louisiana is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association" permitting Blue Cross and Blue Shield of Louisiana to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is not contracting as the agent of the Association. The Group on behalf of itself and its participants further acknowledges and agrees that it has not entered into this Benefit Plan based upon representations by any person other than Blue Cross and Blue Shield of Louisiana and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana shall be held accountable or liable to the Group for any of Blue Cross and Blue Shield of Louisiana's obligations to the Group created under this Benefit Plan. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated in the Schedule of Eligibility, an employee must be actively working for his employer/Group to be entitled to coverage under this Benefit Plan. Each of the following provisions are exceptions to the requirement that the employee be actively working in order for coverage to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. 1. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide by applicable federal or state law, including the Family and Medical Leave Act of 1993 (FMLA) and any amendments or successor provisions, as long as all other eligibility criteria under the law continues to be met. If Subscriber's coverage is terminated during a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate at the end of the billing period in which the leave of absence period expires, or as otherwise described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. 2. When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. 3. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage c overage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage.. " Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.

Liability of Plan Affiliates. The GroupUniversity, on behalf of itself and its participants, hereby expressly acknowledges its understanding that this Benefit Plan agreement constitutes a contract solely between Us and the Group and Blue Cross and Blue Shield of LouisianaUniversity, that Blue Cross and Blue Shield of Louisiana is We are an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (Plans, the "“Association" ” permitting Blue Cross and Blue Shield of Louisiana Us to use the Blue Cross and Blue Shield Service Marks in the State of Louisiana), and that Blue Cross and Blue Shield of Louisiana is We are not contracting as the agent of the Association. The Group University, on behalf of itself and its participants participants, further acknowledges and agrees that it has not entered into Into this Benefit Plan agreement based upon representations by any person other than Blue Cross and Blue Shield of Louisiana Us and that no person, entity, or organization other than Blue Cross and Blue Shield of Louisiana Us shall be held accountable or liable to the Group University for any of Blue Cross and Blue Shield of Louisiana's Our obligations to the Group University created under this Benefit Planagreement. This paragraph shall not create any additional obligations whatsoever on the Our part of Blue Cross and Blue Shield of Louisiana other than those obligations created under other provisions of this agreement. As stated R. Out-of-Area Services‌‌‌‌ Blue Cross and Blue Shield of Louisiana has a variety of relationships with other Blue Cross and/or Blue Shield Plans and their Licensed Controlled Affiliates (“Licensees”). Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross and Blue Shield Association. Whenever You obtain healthcare services outside the geographic area We serve, the Claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described below. When You receive care outside of Our service area, You will receive it from one of two kinds of Providers. Most Providers (“Participating Providers”) contract with the local Blue Cross and/or Blue Shield Licensee in that geographic area (“Host Blue”). Some Providers (“Non-Participating Providers”) do not contract with the Host Blue. We explain below how We pay both kinds of Providers. Inter-Plan Arrangements Eligibility – Claim Types All Claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all Dental Care Benefits when paid as medical Benefits, and those Prescription Drug Benefits or vision care Benefits that may be administered by a third-party contracted by Us to provide the specific service or services. 1. BlueCard® Program Under the BlueCard® Program, when You receive Covered Services within the geographic area served by a Host Blue, We will remain responsible for doing what We agreed to in the Schedule of Eligibilitycontract. However, an employee must be actively working the Host Blue is responsible for his employer/Group to be entitled to coverage under this Benefit Plancontracting with and generally handling all interactions with its Participating Providers. Each When You receive Covered Services outside Our service area and the Claim is processed through the BlueCard® Program, the amount You pay for the Covered Services is calculated based on one of the following provisions are exceptions to as determined by Us: • the requirement billed charges for Your Covered Services; • the negotiated price that the employee be actively working in order for coverage Host Blue makes available to apply. The following provisions are independent of each other and only one need apply for Subscriber and his Dependents to be entitled to continued coverage under this Plan. Company will continue coverage for Subscriber during any leave of absence the Group is required to provide Us; or • an amount determined by applicable federal law. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to Your healthcare Provider. Sometimes, it is an estimated price that takes into account special arrangements with Your healthcare Provider or state lawProvider group that may include types of settlements, including incentive payments, and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare Providers after taking into account the Family same types of transactions as with an estimated price. Estimated pricing and Medical Leave Act average pricing also take into account adjustments to correct for over- or underestimation of 1993 (FMLA) and any amendments or successor provisionspast pricing of Claims, as long as all other eligibility criteria under noted above. However, such adjustments will not affect the law continues to price We have used for Your Claim because they will not be met. If Subscriber's coverage is terminated during applied after a leave under the FMLA, upon return to active full-time employment, Subscriber is entitled to re-enroll for coverage without being subject to otherwise applicable Pre-existing Condition Waiting Periods, so long as the Group maintains coverage with Company. If the Subscriber is not restored to active full-time employment by the end of the leave of absence period, the Subscriber will cease to be eligible and coverage for When a Subscriber is not actively at work due to a health condition, Company will maintain coverage for the Subscriber and any Dependents, as long as the Subscriber remains a bona fide employee of the Group and premiums are Claim has already been paid. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan. When a Subscriber has been granted a documented, approved leave of absence by the employer Group, and the leave of absence is not due to Subscriber’s health, Company will maintain coverage for the Subscriber and any Covered Dependents for a period not to exceed ninety (90) days. Premiums must be paid and Subscriber must remain a bona fide employee of Group during the approved leave period. Group will provide Company with proof of the documented leave, upon request. If Group terminates Subscriber's employment, the Subscriber will cease to be eligible and coverage for the Subscriber and any Dependents will terminate as described in "Termination of a Member's Coverage." Subscriber and Dependents may have the right to continue coverage thereafter under the Continuation of Coverage Rights article of this Benefit Plan.