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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 />exhaustion of the previously mentioned maximum continuation periods <br />or a "terminating event" occurs (e.g. , termination of all group <br />plans provided by Employer, failure of the Member to pay monthly <br />prepayment fees when due, the Member is or becomes covered under any <br />other group plan without limitation as to the totally disabling <br />condition, or the Member is or becomes entitled to Medicare <br />coverage). <br />Benefits of the continuation plan are identical to this group plan. <br />The cost of the coverage will be 102% of the applicable group rate <br />(including any portion previously paid by Employer) during the <br />period of basic COBRA coverage and 150% of the applicable group rate <br />during the period of "extended" coverage (Le. , 19th through 29th <br />month) . <br />UNDER COBRA, ALL NOTIFICATION AND OTHER COMPLIANCE RESPONSIBILITIES <br />ARE THE SOLE OBLIGATION OF EMPLOYER. Please consult Employer with <br />your questions regarding continuation of group coverage. Employees <br />should receive notice from Employer's plan administrator of their <br />eligibility for group continuation coverage if a qualifying event <br />occurs. This notice should be sent the Employee's Family Members in <br />the event of the Employee's death. Failure of a Subscriber or <br />affected Family Member to notify Employer within 60 days of a <br />divorce, legal separation or a Dependent child's loss of eligibility <br />will result in loss of eligibility for group continuation coverage. <br />Employer must notify OHS of the occurrence and related date of any <br />qualifying event within 30 days of the incidence thereof. If the <br />Member fails to provide such notice, then the Member shall not be <br />entitled to elect continuation coverage under this plan. <br />COBRA coverage will begin at the time group coverage ends if the <br />Member applies and pays the required prepayment fees within 60 days <br />after receiving notice of eligibility for continuation coverage or <br />the date of loss of coverage, whichever is later. Electing Members <br />will be billed for coverage on a monthly basis. Payment is due on <br />the first day of each coverage month. Coverage will be canceled on <br />midnight of the last day for which payment was last made if <br />prepaYment fees are not received within 30 days of the due date. <br />GRIEVANCE PROCEDURES <br /> General <br />As a condition of enrollment and a contractual term of the Group <br />Agreement and this Evidence of Coverage, Members are required to <br />submit all grievances through OHS' internal grievance procedures. <br />OHS' internal grievance procedures are required to be completed <br />before the Member may file for arbitration, as specified below, for <br />final and binding resolution of the grievance. (Note: For the <br />purposes of these procedures, "grievances", "appeals" and <br /> - 11 - <br /> .-.---.-. " <br />
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