Agmt94 Managed Health Network - Laserfiche WebLink

Browse Search

o If, in the determination of OHS, a Member's behavior is disruptive, unruly, abusive or uncooperative to the extent that the ability of OHS or the Member's attending Participating Provider to manage the care of the Member is significantly impaired, or if the Member threatens the life or well-being of an employee of OHS or a Participating Provider, termination will be effective after 15 days' notice from OHS. o If a Subscriber makes a material false statement as to his or her health status or that of any of his or her Family Members, or obtains or attempts to obtain Covered Services by means of deception or false, misleading or fraudulent information, acts or omissions, OHS may terminate coverage immediately upon notice. If a Member's coverage is terminated under this plan by OHS and the Member has reason to believe that the termination was based upon the Member's health status or requirements for health care services, the Member may request a review of the termination by the California Commissioner of Corporations. Upon notice of termination of the Group Agreement by either OHS or Employer, Employer is responsible for providing notice of same to each Subscriber. MEMBER'S LIABILITY FOR PAYMENT When a Member receives Covered services from a Participating Provider, the Member is responsible for any applicable Copayments and for payment for non-Covered Services or benefits in excess of specified limitations. If OHS does not pay a Participating Provider for Covered services, you will not be liable to the provider for any sums owed by OHS. If you receive services and supplies from a non-Participating Provider, you will be responsible for payment. CONTINUATION OF GROUP COVERAGE In accordance with the Consolidated Omnibus Budget Reconciliation Act ("COBRA"), a Member who loses coverage under this plan is entitled under certain conditions to elect to continue group coverage if Employer is not exempted under COBRA. Generally, COBRA requires all employers of 20 or more employees to offer to continue group health coverage for up to 18 months to employees and their Dependents who lose coverage due to termination of employment (except for gross misconduct) or reduction in hours worked, and for up to 36 months to Dependents who lose coverage due to the death of the Employee, divorce or legal separation from the Employee or to children who no longer qualify as covered Dependents. II Extended" coverage of up to 29 months is available to certain COBRA beneficiaries who are disabled at the time of their qualifying event and entitled to Social Security disability benefits. continuation of group coverage rights under COBRA continue until either the - 10 - '''~'."'''''''r-"''-''''" ---''