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Agenda - 06-28-1989
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Agenda - 06-28-1989
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3/10/2017 4:29:57 PM
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BOCC
Date
6/28/1989
Meeting Type
Regular Meeting
Document Type
Agenda
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32 <br /> SECTION VI <br /> REIMBURSEMENT OF ELIGIBLE EXPENSES FOR TREATMENT <br /> BY NON-PARTICIPATING PROVIDERS <br /> 1. Claim Form <br /> For a Member to be reimbursed for Eligible Expenses incurred in <br /> connection with any medical care or treatment provided by <br /> non-participating physicians or other non-participating <br /> Providers, a Claim Form or formal bill must be submitted by the <br /> Member and received at the Plan's home office within ninety (90) <br /> • days after the date the Member incurs such Eligible Expenses. <br /> Failure to furnish a Claim Form or formal bill within the time <br /> required shall not invalidate nor reduce any claim, provided <br /> such Claim Form or formal bill is furnished as soon as <br /> reasonably possible and in no event, later than one (1) year <br /> from the date at which time the services were provided. <br /> 2. Payment of Claims <br /> Upon timely receipt of the Claim Form or formal bill, the Plan <br /> will pay for Eligible Expenses incurred in connection with <br /> Covered Health Services. Benefits under this Contract may be <br /> paid in whole or in part either to the Subscriber who incurs the . <br /> Eligible Expenses (or whose Family Dependent incurs the Eligible <br /> Expenses) .or to the hospital, person, or other entity rendering <br /> the health care services. <br /> 3. Legal Actions <br /> No action at law or in equity shall be brought to recover under <br /> this Contract prior to the expiration of sixty (60) days after <br /> the Claim Form and/or requested supporting information, if any, <br /> has been filed in accordance with the requirements of this <br /> 27 <br />
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