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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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44 <br /> If the termination of the Member's eligibility is by reason of <br /> moving or out of the Plan's Service Area that Member may apply for a <br /> Direct Payment Agreement from an insurance company offering such <br /> Coverage to the former Member without evidence of insurability. This <br /> Application Form, is available from the Plan, and it must be submitted <br /> within thirty (30) days of termination. The out of Service Area Direct <br /> payment Agreement will provide for the same benefits schedule and rates <br /> being offered by the insurer to other insureds within that state <br /> eligible for such a Direct Payment Agreement. <br /> The Members shall be eligible to continue their Direct Payment <br /> Agreement only as long as they are not covered by, or eligible for, <br /> coverage by any substantially similar insurance policy, prepaid plan, or <br /> other health benefit plan or program offered by any party including the <br /> federal, state, or local government, which together with the Direct <br /> Payment Agreement would result in over insurance or duplication <br /> of benefits according to standards on file with the NAIC. The Direct <br /> Payment Agreement Coverage will terminate when the Member becomes <br /> eligible for Medicare Coverage by reason of age. <br /> The Group agrees to notify Members of their right to convert to a <br /> Direct Payment Agreement upon termination of a Subscriber's employment <br /> • or membership in the Group. Such notice must be given within fifteen <br /> (IS) days of the date of the event causing the termination of the <br /> Subscriber's Group Coverage by mailing the notice to the Subscriber's <br /> last known address. The Group agrees to pay the Plan's additional <br /> administrative expenses if it fails to provide such timely notice, as <br /> provided in this paragraph, and the Subscriber later converts to a <br /> 39 <br />
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