Summaries of Benefits and Coverage Sample Clauses

Summaries of Benefits and Coverage. Under section 2715 of the Public Health Service Act, created by the Patient Protection and Affordable Care Act (the Affordable Care Act) and as implemented by summary of benefits and coverage regulations, certain employer groups and their employees who are eligible to enroll in, or who are enrolled in, the employer group’s health plan(s) are entitled to a Summary of Benefits and Coverage (and the uniform Glossary of Health Coverage and Medical Terms, which is available on the U.S. Departments of Labor and Health and Human Services Web sites as well as the Blue Cross and Blue Shield Web site) in certain circumstances on and after September 23, 2012. Blue Cross and Blue Shield will provide Summaries of Benefits and Coverage to you in accordance with the provisions described in this Agreement. You agree that Blue Cross and Blue Shield will not be responsible for providing Summaries of Benefits and Coverage to your employees. Blue Cross and Blue Shield Responsibilities For each of the Blue Cross and Blue Shield standard plan design(s) offered to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide you with either a Web site address where you can obtain a copy of the standard Summary of Benefits and Coverage or, upon your request, a copy of the standard Summary of Benefits and Coverage in electronic (PDF) and/or printed format. Access to Summaries of Benefits and Coverage for standard plan designs will be available at least 60 days prior to your coverage effective date or your subsequent renewal date, or within seven business days of your request to Blue Cross and Blue Shield. In the event you have chosen to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide a copy of the Summary of Benefits and Coverage for each customized plan design to you in accordance with the Affordable Care Act and associated regulations. If there are changes that necessitate updating the Summary of Benefits and Coverage after it is provided to you, Blue Cross and Blue Shield will provide the updated Summary of Benefits and Coverage to you within seven business days of the change(s) being identified, but only when the requested changes reflect health care benefits provided by Blue Cross and Blue Shield. Generally, any Summary of Benefits and Coverage provided by Blue Cross and Blue Shield will describe only the health care benefits provided under...
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Summaries of Benefits and Coverage. Under section 2715 of the Public Health Service Act, created by the Patient Protection and Affordable Care Act (the Affordable Care Act) and as implemented by summary of benefits and coverage regulations, certain employer groups and their employees who are eligible to enroll in, or who are enrolled in, the employer group’s health plan(s) are entitled to a Summary of Benefits and Coverage (and the uniform Glossary of Health Coverage and Medical Terms, which is available on the U.S. Departments of Labor and Health and Human Services Web sites as well as the Blue Cross and Blue Shield Web site) in certain circumstances on and after September 23, 2012. Blue Cross and Blue Shield will provide Summaries of Benefits and Coverage to you in accordance with the provisions described in this Agreement. You agree that Blue Cross and Blue Shield will not be responsible for providing Summaries of Benefits and Coverage to your employees.
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Related to Summaries of Benefits and Coverage

  • Explanation of Benefits Contractor shall send each Enrollee an Explanation of Benefits to Enrollees in Plans that issue Explanation of Benefits or similar documents as required by Federal and State laws, rules, and regulations. The Explanation of Benefits and other documents shall be in a form that is consistent with industry standards.

  • Coordination of Benefits The coordination of benefits (COB) provision applies when a Member has health care coverage under more than one plan. Plan is defined below. The order of benefit determination rules govern the order in which each plan will pay a claim for benefits. The plan that pays first is called the primary plan. The primary plan must pay benefits according to its policy terms without regard to the possibility that another plan may cover some expenses. The plan that pays after the primary plan is the secondary plan. In no event will a secondary plan be required to pay an amount in excess of its maximum benefit plus accrued savings. If the Member is covered by more than one health benefit plan, and the Member does not know which is the primary plan, the Member or the Member’s provider should contact any one of the health plans to verify which plan is primary. The health plan the Member contacts is responsible for working with the other plan to determine which is primary and will let the Member know within 30 calendar days. All health plans have timely claim filing requirements. If the Member or the Member’s provider fails to submit the Member’s claim to a secondary health plan within that plan’s claim filing time limit, the plan can deny the claim. If the Member experiences delays in the processing of the claim by the primary health plan, the Member or the Member’s provider will need to submit the claim to the secondary health plan within its claim filing time limit to prevent a denial of the claim. If the Member is covered by more than one health benefit plan, the Member or the Member’s provider should file all the Member’s claims with each plan at the same time. If Medicare is the Member’s primary plan, Medicare may submit the Member’s claims to the Member’s secondary carrier.

  • Integration of Benefits If you are disabled, the monthly payments under this plan will be reduced by the amount of any Periodic Payments you are entitled to apply for and receive with respect to the disability under any Workplace Safety & Insurance Act, the Canada Pension Plan or the Quebec Pension Plan. The amounts deducted will not include any additional benefits payable for children or subsequent cost of living increases.

  • Payment of Benefits a) In computing the amount of disability benefits, disability will be considered as starting from the first day of disability; however, an employee must be certified by a medical practitioner for the disability within the first three days of disability. In the event that the employee is not certified within the first three days, disability will be considered as starting two complete days prior to the day that the employee is actually certified by a medical practitioner.

  • PORTABILITY OF BENEFITS The following benefits are portable:

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