Plan Contact Information. Contact your employer for the name, address and telephone number of the party responsible for administering your COBRA continuation coverage. The purpose of this section of your Certificate is to explain the options available for continuing your coverage after termination, as it relates to Illinois state legis lation. The provisions which apply to you will depend upon your status at the time of termination. The provisions described in Article A will apply if you are the Xxx gible Person (as specified in the Group Policy) at the time of termination. The provisions described in Article B will apply if you are the spouse of a retired Xxx xxxxx Person or the party to a Civil Union with a retired Eligible Person and are at least 55 years of age or the former spouse of an Eligible Person or the former party to a Civil Union with a retired Eligible Person who has died or from whom you have been divorced or from whom your Civil Union has been dissolved. The provisions described in Article C will apply if you are the dependent child of an Eligible Person who has died or if you have reached the limiting age under this Certificate and not eligible to continue coverage as provided under Article B. Your continued coverage under this Certificate will be provided only as specified below. Therefore, after you have determined which Article applies to you, please read the provisions very carefully.
Plan Contact Information. For additional information about the Plan or your rights under COBRA continuation coverage, contact SHL’s Member Services Department by calling 0-000-000-0000.
Plan Contact Information. For additional information about the Plan or your rights under COBRA continuation coverage, contact HPN’s Member Services Department by calling 0-000-000-0000.
Plan Contact Information. Contact your employer for the name, address and telephone number of the party responsible for administering your COBRA continuation coverage. 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. Form No. NTC -1731 -0907 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.
Plan Contact Information. Contact your employer for the name, address and telephone number of the party responsible for administering your COBRA continuation coverage. The purpose of this section of your Certificate is to explain the options available for continuing your coverage after termination, as it relates to Illinois state legis lation. The provisions which apply to you will depend upon your status at the time of termination. The provisions described in Article A will apply if you are the Xxx gible Person (as specified in the Group Policy) at the time of termination. The GB‐16 HCSC 17 provisions described in Article B will apply if you are the spouse of a retired Xxx xxxxx Person or the party to a Civil Union with a retired Eligible Person and are at least 55 years of age or the former spouse of an Eligible Person or the former party to a Civil Union with a retired Eligible Person who has died or from whom you have been divorced or from whom your Civil Union has been dissolved. The provisions described in Article C will apply if you are the dependent child of an Eligible Person who has died or if you have reached the limiting age under this Certificate and not eligible to continue coverage as provided under Article B. Your continued coverage under this Certificate will be provided only as specified below. Therefore, after you have determined which Article applies to you, please read the provisions very carefully.
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 (HMO) and is required by legislation to be provided to you. If you have questions regarding this notice, call Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, at 1- 877- 299- 2377 or write us at P.O. Box 660044,
