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Agmt94 Managed Health Network
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Agmt94 Managed Health Network
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Last modified
7/5/2005 2:32:18 PM
Creation date
11/4/2004 2:05:29 PM
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Template:
Agreement
Contractor Name
Managed Health Network formerly Occupational Health Services
RMP File Number
304
Date
7/14/1994
Reso Ref
12379 12687 13007
Box
5858
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<br />ELIGIBILITY PROVISIONS <br />The Group Agreement specifies the eligibility prerequisites and <br />terms and conditions of eligibility under this plan. <br />COMMENCEMENT OF COVERAGE <br />The Group Agreement specifies the time and the conditions under <br />which coverage shall start. <br />BENEFIT CHANGES <br />OHS will notify Employer at least 30 days in advance of any changes <br />in benefits. <br />TERMINATION PROVISIONS <br />THE FOLLOWING DESCRIBES SOME OF THE USUAL TERMINATION PROVISIONS, <br />BUT YOU SHOULD ASK EMPLOYER IF THERE ARE ANY DIFFERENT PROVISIONS IN <br />THE GROUP AGREEMENT. <br />Employer can terminate this plan: <br />0 By giving 60 days' written notice of termination to OHS prior to <br />the annual renewal date of this plan. <br />OHS can terminate a Member's coverage in any of the following <br />events: <br />o If prepayment fees are not paid according to the Agreement, <br />termination will be effective on midnight of the last day of the <br />month for which prepayment fees were last received by OHS. <br />0 If a Subscriber ceases to be eligible according to the provisions <br />listed in the Group Agreement, coverage will be terminated for the <br />Subscriber and any enrolled Family Members effective on midnight of <br />the last day of the month in which loss of eligibility occurred. <br />0 If a Family Member ceases to be eligible according to the <br />provisions listed in the Group Agreement, coverage will be <br />terminated only for that person effective on midnight of the last <br />day of the month in which loss of eligibility occurred. <br />0 On midnight of the last day of the month in which a Member no <br />longer works or maintains a permanent residence within california, <br />coverage will be terminated for the Subscriber and any enrolled <br />Family Members effective on midnight of the last day of the month in <br />which such event occurred. <br />0 If, in the determination of OHS, a Member refuses to establish <br />and maintain relationships with a Participating Provider to assure <br />continuity of care and appropriate use of Covered Services, <br />termination will be effective after 15 days' notice from OHS. <br /> - 9 - <br /> , ----.-""'',,'',--''',,-.,, -r--'''''''' ' ".., <br />
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