Common use of Prior Coverage Clause in Contracts

Prior Coverage. If a member is confined as an inpatient in a hospital on the effective date of this agreement, and prior coverage terminating immediately before the effective date of this agreement furnishes benefits for the hospitalization after the termination of prior coverage, then services and benefits will not be covered under this agreement for that member until the member is discharged from the hospital or benefits under the prior coverage are exhausted, whichever is earlier. If there is no prior coverage or no continuation of inpatient coverage after the effective date, your Ambetter of Illinois insured by Celtic Insurance Company coverage will apply for covered services related to the inpatient coverage after your effective date. Ambetter of Illinois insured by Celtic Insurance Company coverage requires you notify Ambetter of Illinois insured by Celtic Insurance Company within two days of your effective date so we can review and authorize medically necessary services. If services are at a non-contracted hospital, claims will be paid at the Ambetter of Illinois insured by Celtic Insurance Company allowed amount and you may be billed for any balance of costs above the Ambetter of Illinois insured by Celtic Insurance Company allowed amount.