Common use of Verification of Benefits Clause in Contracts

Verification of Benefits. Verification of Benefits is available for Members or authorized healthcare Providers on behalf of Members. You may call Customer Service with a medical benefits inquiry or Verification of Benefits during normal business hours (8:00 a.m. to 5:00 p.m. eastern time). Please remember that a benefits inquiry or Verification of Benefits is NOT a verification of coverage of a specific medical procedure. • Verification of Benefits is NOT a guarantee of payment. • If the verified service requires Prior Authorization, please call 0-000-000-0000. Prior Authorization – In-Network (also known as Pre-Certification) For Prior Authorization call 0-000-000-0000. • Required by your Physician or facility for ALL in-patient hospital admissions that are In- Network. • Please notify us by the next business day of an emergency or maternity admission; • Non-Urgent Care pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). • Emergency services do NOT require Prior Authorization. Prior Authorization – Out-of-Network (also known as Pre-Certification) For Prior Authorization call 0-000-000-0000. • Required by YOU for ALL in-patient hospital admissions that are Outdo--Network. • YOU are responsible for notifying us within 1-business day of an emergency or maternity admission, or your claim may be denied. • Non-Urgent Care Prior Authorizations can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). • Emergency services do NOT require Prior Authorization. Prior Authorization is a guarantee of payment f o r C o v e r e d S e r v i c e s ; as described in this section (and Alliant will pay up to the reimbursement level of this Contract when the Covered Services are performed within the time limits assigned through Coverage Certification) except for the following situations: • The Member is no longer covered under this Contract at the time the services are received; • The benefits under this Contract have been exhausted (examples of this include day limits); • In cases of fraud or misrepresentation. Prior Authorization approvals apply only to services which have been specified in the Prior Authorization and/or prior authorization list available on our website under provider resources. A Prior Authorization approval does not apply to any other services; other than the specific service being pre-certified. Payment or authorization of such a service does not require or apply to payment of claims at a later date regardless of whether such later claims have the same, similar or related diagnoses. Summary Notice This Certificate explains your health care benefit plan. This Certificate is written in an easy-to-read language to help you understand your health care benefits. A thorough understanding of your coverage will enable you to use your benefits wisely. Please read this Certificate carefully. If you have any questions about your benefits as presented in this Certificate, please call our Customer Service at 1-800-811-4793. The purpose of this Certificate is to help you understand your coverage. Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente que aparece xx xxxxx de su tarjeta de identificación o en el folleto de inscripción. English translation: If you need Spanish-language assistance to understand this document, you may request it at no additional cost by calling the customer service number on the back of your ID card or in your enrollment booklet.

Verification of Benefits. Verification of Benefits is available for Members or authorized healthcare Providers on behalf of Members. You may call Customer Service with a medical benefits inquiry or Verification of Benefits during normal business hours (8:00 a.m. to 5:00 p.m. eastern time). Please remember that a benefits inquiry or Verification of Benefits is NOT a verification of coverage of a specific medical procedure. •  Verification of Benefits is NOT a guarantee of payment. •  If the verified service requires Prior Authorization, please call 0-000-000-0000. Prior Authorization – In-Network (also known as Pre-Certification) For Prior Authorization call 0-000-000-0000. •  Required by your Physician or facility for ALL in-patient hospital admissions that are In- Network. •  Please notify us by the next business day of an emergency or maternity admission; •  Non-Urgent Care pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). •  Emergency services do NOT require Prior Authorization. Prior Authorization – Out-of-Network (also known as Pre-Certification) For Prior Authorization call 0-000-000-0000. •  Required by YOU for ALL in-patient hospital admissions that are Outdo--Network. •  YOU are responsible for notifying us within 1-business day of an emergency or maternity admission, or your claim may be denied. •  Non-Urgent Care Prior Authorizations can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). •  Emergency services do NOT require Prior Authorization. Prior Authorization is a guarantee of payment f o r C o v e r e d S e r v i c e s ; as described in this section (and Alliant will pay up to the reimbursement level of this Contract when the Covered Services are performed within the time limits assigned through Coverage Certification) except for the following situations: •  The Member is no longer covered under this Contract at the time the services are received; •  The benefits under this Contract have been exhausted (examples of this include day limits); •  In cases of fraud or misrepresentation. Prior Authorization approvals apply only to services which have been specified in the Prior Authorization and/or prior authorization list available on our website under provider resources. A Prior Authorization approval does not apply to any other services; other than the specific service being pre-certified. Payment or authorization of such a service does not require or apply to payment of claims at a later date regardless of whether such later claims have the same, similar or related diagnoses. Summary Notice This Certificate explains your health care benefit plan. This Certificate is written in an easy-to-read language to help you understand your health care benefits. A thorough understanding of your coverage will enable you to use your benefits wisely. Please read this Certificate carefully. If you have any questions about your benefits as presented in this Certificate, please call our Customer Service at 1-800-811-4793. The purpose of this Certificate is to help you understand your coverage. Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente que aparece xx xxxxx de su tarjeta de identificación o en el folleto de inscripción. English translation: If you need Spanish-language assistance to understand this document, you may request it at no additional cost by calling the customer service number on the back of your ID card or in your enrollment booklet.

Verification of Benefits. Verification of Benefits is available for Members or authorized healthcare Providers on behalf of Members. You may call Customer Service with a medical benefits inquiry or Verification of Benefits during normal business hours (8:00 a.m. to 5:00 p.m. eastern time). Please remember that a benefits inquiry or Verification of Benefits is NOT a verification of coverage of a specific medical procedure. •  Verification of Benefits is NOT a guarantee of payment. •  If the verified service requires Prior Authorizationpre-certification, please call 0-000-000-0000. Prior Authorization Pre-Certification – In-Network (also known as Pre-CertificationPrior Authorization) For Prior Authorization pre-certification call 0-000-000-0000. •  Required by your Physician or facility for ALL in-patient hospital admissions that are In- Network. •  Please notify us by the next business day of an emergency or maternity admission; •  Non-Urgent Care pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). •  Emergency services do NOT require Prior AuthorizationPre-Certification. Prior Authorization Pre-Certification – Out-of-Network (also known as Pre-CertificationPrior Authorization) For Prior Authorization pre-certification call 0-000-000-0000. •  Required by YOU for ALL in-patient hospital admissions that are Outdo--Network. •  YOU are responsible for notifying us within 1-business day of an emergency or maternity admission, or your claim may be denied. •  Non-Urgent Care Prior Authorizations pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). •  Emergency services do NOT require Prior AuthorizationPre-Certification. Prior Authorization Pre-Certification is a guarantee of payment f o r C o v e r e d S e r v i c e s ; as described in this section (and Alliant will pay up to the reimbursement level of this Contract when the Covered Services are performed within the time limits assigned through Coverage Certification) except for the following situations: •  The Member is no longer covered under this Contract at the time the services are received; •  The benefits under this Contract have been exhausted (examples of this include day limits); •  In cases of fraud or misrepresentation. Prior Authorization Pre- Certification approvals apply only to services which have been specified in the Prior Authorization pre-certification and/or prior authorization list available on our website under provider resources. A Prior Authorization pre-certification approval does not apply to any other services; other than the specific service being pre-certified. Payment or authorization of such a service does not require or apply to payment of claims at a later date regardless of whether such later claims have the same, similar or related diagnoses. Summary Notice This Certificate explains your health care benefit plan. This Certificate is written in an easy-to-read language to help you understand your health care benefits. A thorough understanding of your coverage will enable you to use your benefits wisely. Please read this Certificate carefully. If you have any questions about your benefits as presented in this Certificate, please call our Customer Service at 1-800-811-4793. The purpose of this Certificate is to help you understand your coverage. Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente que aparece xx xxxxx de su tarjeta de identificación o en el folleto de inscripción. English translation: If you need Spanish-language assistance to understand this document, you may request it at no additional cost by calling the customer service number on the back of your ID card or in your enrollment booklet.

Verification of Benefits. ‌ Verification of Benefits is available for Members or authorized healthcare Providers on behalf of Members. You may call Customer Service with a medical benefits inquiry or Verification of Benefits during normal business hours (8:00 a.m. to 5:00 p.m. eastern time). Please remember that a benefits inquiry or Verification of Benefits is NOT a verification of coverage of a specific medical procedure. • Verification of Benefits is NOT a guarantee of payment. • If the verified service requires Prior Authorizationpre-certification, please call 0-000-000-0000. Prior Authorization Pre-Certification – In-Network (also known as Pre-CertificationPrior Authorization) For Prior Authorization pre-certification call 0-000-000-0000. • Required by your Physician or facility for ALL in-patient hospital admissions that are In- Network. • Please notify us by the next business day of an emergency or maternity admission; • Non-Urgent Care pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). • Emergency services do NOT require Prior AuthorizationPre-Certification. Prior Authorization Pre-Certification – Out-of-Network (also known as Pre-CertificationPrior Authorization) For Prior Authorization pre-certification call 0-000-000-0000. • Required by YOU for ALL in-patient hospital admissions that are Outdo--Network. • YOU are responsible for notifying us within 1-business day of an emergency or maternity admission, or your claim may be denied. • Non-Urgent Care Prior Authorizations pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time). • Emergency services do NOT require Prior AuthorizationPre-Certification. Prior Authorization Pre-Certification is a guarantee of payment f o r C o v e r ver e d S e r v i c e s er vi ces ; as described in this section (and Alliant will pay up to the reimbursement level of this Contract when the Covered Services are performed within the time limits assigned through Coverage Certification) except for the following situations: • The Member is no longer covered under this Contract at the time the services are received; • The benefits under this Contract have been exhausted (examples of this include day limits); • In cases of fraud or misrepresentation. Prior Authorization Pre- Certification approvals apply only to services which have been specified in the Prior Authorization pre-certification and/or prior authorization list available on our website under provider resources. A Prior Authorization pre-certification approval does not apply to any other services; other than the specific service being pre-certified. Payment or authorization of such a service does not require or apply to payment of claims at a later date regardless of whether such later claims have the same, similar or related diagnoses. Summary Notice Notice‌ This Certificate explains your health care benefit plan. This Certificate is written in an easy-to-read language to help you understand your health care benefits. A thorough understanding of your coverage will enable you to use your benefits wisely. Please read this Certificate carefully. If you have any questions about your benefits as presented in this Certificate, please call our Customer Service at 1-800-811-4793. The purpose of this Certificate is to help you understand your coverage. Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente que aparece xx xxxxx de su tarjeta de identificación o en el folleto de inscripción. English translation: If you need Spanish-language assistance to understand this document, you may request it at no additional cost by calling the customer service number on the back of your ID card or in your enrollment booklet.