Third Party Liability sections Sample Clauses

Third Party Liability sections. If services are provided by a Non-Participating Provider, the Member is responsible for all amounts Blue Shield does not pay. When a Benefit specifies a Benefit maximum and that Benefit maximum has been reached, the Member is responsible for any charges above the Benefit maximums. No Maximum Aggregate Payment Amount There is no maximum limit on the aggregate payments by Blue Shield for Covered Services provided under the Agreement. No Annual Dollar Limit on Essential Health Benefits This health plan contains no annual dollar limits on essential health benefits as defined by federal law. Independent Contractors Providers are neither agents nor employees of Blue Shield but are independent contractors. In no instance shall Blue Shield be liable for the negligence, wrongful acts, or omissions of any person receiving or providing services, including any Physician, Hospital, or other provider or their employees. Assignability Coverage or any Benefits of this Agreement may not be assigned without the written consent of Blue Shield. Possession of a Blue Shield ID card confers no right to Covered Services or other Benefits of this Agreement. To be entitled to services, the Member must be a Subscriber who has been enrolled by Blue Shield and who has maintained enrollment under the terms of this Agreement. Participating Providers are paid directly by Blue Shield. If the Member receives Covered Services from a Non-Participating Provider, Blue Shield at its sole discretion, may make payment to the Subscriber or directly to the Non-Participating Provider. If Blue Shield pays the Non-Participating Provider directly, such payment does not create a third party beneficiary or other legal relationship between Blue Shield and the Non-Participating Provider. In addition, whether Blue Shield pays the Subscriber of the Non-Participating Provider, the Subscriber remains responsible for all charges up to the Non-Participating Provider’s billed amount.