Withdrawal or Cessation of Services a. KFHPWA may determine to withdraw from a Service Area or from a segment of its Service Area after KFHPWA has demonstrated to the Washington State Office of the Insurance Commissioner that KFHPWA’s clinical, financial or administrative capacity to service the covered Members would be exceeded.
b. KFHPWA may determine to cease to offer the Group’s current plan and replace the plan with another plan offered to all covered Members within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. KFHPWA may also allow unrestricted conversion to a fully comparable KFHPWA product. KFHPWA will provide written notice to each covered Member of the discontinuation or non-renewal of the plan at least 90 days prior to discontinuation.
Withdrawal or Cessation of Services a. GHC may determine to withdraw from a Service Area or from a segment of its Service Area after GHC has demonstrated to the Washington State Office of the Insurance Commissioner that GHC’s clinical, financial or administrative capacity to service the covered Members would be exceeded.
b. GHC may determine to cease to offer the Group’s current plan and replace the plan with another plan offered to all covered Members within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. GHC may also allow unrestricted conversion to a fully comparable GHC product. GHC will provide written notice to each covered Member of the discontinuation or non-renewal of the plan at least ninety (90) days prior to discontinuation. Dear Group Health Subscriber: This is your 2012 Group Health Benefit Booklet (Certificate of Coverage). It explains the services and benefits you and those enrolled on your contract are entitled to receive from Group Health Cooperative. Sections of this document may be bolded and italicized, which identifies changes that Group Health has made to the plan. The benefits reflected in this booklet were approved by your employer or association who contracts with Group Health for your healthcare coverage. If you are eligible for Medicare, please read Section IV.J. as it may affect your prescription drug coverage. We recommend you read it carefully so you’ll understand not only the benefits, but the exclusions, limitations, and eligibility requirements of this certificate. Please keep this certificate for as long as you are covered by Group Health. We will send you revisions if there are any changes in your coverage. This certificate is not the contract itself; you can contact your employer or group administrator if you wish to see a copy of the contract (Medical Coverage Agreement). We’ll gladly answer any questions you might have about your Group Health benefits. Please call our Group Health Customer Service Center at (000) 000-0000 in the Seattle area, or toll-free in Washington, 0-000-000-0000. Thank you for choosing Group Health Cooperative. We look forward to working with you to preserve and enhance your health. Very truly yours, Xxxxx Xxxxxxxxx President PA-1133a12, CA-1395a12 ,CA-111012,CA-136012,CA-182412,CA-11712,CA-138512,CA-334612 CA-371212, CA-376812, CA-3817 C33132-4925700a A. Accessing Care B. Cost Shares C. Subs...
Withdrawal or Cessation of Services a. Group Health may determine to withdraw from a Service Area or from a segment of its Service Area after Group Health has demonstrated to the Washington State Office of the Insurance Commissioner that Group Health’s clinical, financial or administrative capacity to service the covered Members would be exceeded.
b. Group Health may determine to cease to offer the Group’s current plan and replace the plan with another plan offered to all covered Members within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. Group Health may also allow unrestricted conversion to a fully comparable Group Health product. Group Health will provide written notice to each covered Member of the discontinuation or non-renewal of the plan at least 90 days prior to discontinuation.
Withdrawal or Cessation of Services. CHPW may determine to withdraw from a Service Area after CHPW has demonstrated to the Washington State Office of the Insurance Commissioner that CHPW’s clinical, financial or administrative capacity to serve the covered Subscribers would be exceeded. CHPW may determine to cease to offer the plan and replace the plan with another plan offered to all covered Subscribers within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. CHPW may also allow unrestricted conversion to a fully comparable CHPW product. CHPW will provide written notice to each covered Subscriber of the discontinuation or non-renewal of the plan at least 90 days prior to discontinuation. CHPW must provide the Washington State Office of the Insurance Commissioner at least 60 days advance notice in the event of discontinuation of this plan. In the event of cancellation, services received prior to the effective date of such cancelation shall be covered in accordance with the terms of this Agreement. Nondiscrimination. CHPW and its vendors and other contracted partners comply with all applicable federal, state, and local civil rights laws and do not discriminate, exclude, or treat people differently on the basis of race, color, national origin, ancestry, religion, sex, gender, marital status, age, sexual orientation, the presence of physical or mental disabilities, or any other reason(s) prohibited by law in its employment practices and or in the provision of health care services.
Withdrawal or Cessation of Services a. GHO may determine to withdraw from a Service Area or from a segment of its Service Area after GHO has demonstrated to the Washington State Office of the Insurance Commissioner that GHO’s clinical, financial or administrative capacity to service the covered Members would be exceeded.
b. GHO may determine to cease to offer the Group’s current plan and replace the plan with another plan offered to all covered Members within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. GHO may also allow unrestricted conversion to a fully comparable GHO product. GHO will provide written notice to each covered Member of the discontinuation or non-renewal of the plan at least ninety (90) days prior to discontinuation.
Withdrawal or Cessation of Services a. KFHPWA may determine to withdraw from a Service Area or from a segment of its Service Area after KFHPWA has demonstrated to the Washington State Office of the Insurance Commissioner that KFHPWA’s clinical, financial or administrative capacity to service the covered Members would be exceeded.
b. KFHPWA may determine to cease to offer the plan and replace the plan with another plan offered to all covered Members within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. KFHPWA may also allow unrestricted conversion to a fully comparable KFHPWA product. KFHPWA will provide written notice to each covered Member of the discontinuation or non-renewal of the plan at least 90 days prior to discontinuation. A. Accessing Care 8 B. Recommended Treatment. 10 C. Preauthorization. 10 D. Second Opinions. 11 E. Unusual Circumstances. 11 F. Utilization Management. 11 A. Premium 11 B. Financial Responsibilities for Covered Services. 11 C. Financial Responsibilities for Non-Covered Services. 12
Withdrawal or Cessation of Services. CHPW may determine to withdraw from a Service Area after CHPW has demonstrated to the Washington State Office of the Insurance Commissioner that CHPW’s clinical, financial or administrative capacity to serve the covered Subscribers would be exceeded. CHPW may determine to cease to offer the plan and replace the plan with another plan offered to all covered Subscribers within that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan. CHPW may also allow unrestricted conversion to a fully comparable CHPW product. CHPW will provide written notice to each covered Subscriber of the discontinuation or non‐renewal of the plan at least ninety (90) days prior to discontinuation. Nondiscrimination. CHPW and its vendors do not discriminate on the basis of race, color, national origin, ancestry, religion, gender, marital status, age, sexual orientation, the presence of physical or mental disabilities, or any other reason(s) prohibited by law in its employment practices and or in the provision of health care services.
