Reso 2010-1529 - Laserfiche WebLink

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) 8.07 Extension of benefits. In the event this Contract is terminated for any reason, except nonpayrnent of premium or as set forth in Subsection 8.07.03, such termination shall be without prejudice to any continuous losses to a Member which commenced while this Contract was in force, but any extension of benefits beyond the date of termination shall be predicated upon the continnous Total Disability as defined in Section 2.56, of the Member and shall be limited to payment for the treatment of a specific accident or illness incurred while the Member's coverage under this Contract was effective. 8.07.01 8.07.02 8.07.03 ) The extension of benefits covered under this Contract shall be limited to the occurrence of the earliest of the following events: a) The expiration of 12 months; b) Such time as the Member is no longer totally disabled; c) A succeeding carrier elects to provide replacement coverage without Limitation as to the disability condition; or d) The maximum benefits payable under this Contract have been paid. In the case of maternity coverage, when not covered by the succeeding carrier, a reasonable extension of this Contract1s benefits will be provided to cover maternity expenses for a covered pregnancy that commenced while the policy was in effect. The extension shall be for the period of that pregnancy only and shall not be based upon Total Disability. Except as provided above, no Subscriber is entitled to an extension of benefits if the termination by AvMed of this Contract is based upon one or morc of the following reasons: a) Fraud or intentional misrepresentation in applying for any benefits under this Contract; b) Disenrollment for cause; or c) The Subscriber has left the geographic Service Area of AvMed with the intent to relocate or establish a new residence outside AvMed's Service Area. } ) IX. SCHEDULE OF BASIC BENEFITS The A vMed Choice product has several special features that can influence the level of coveragc and how much you payout of pocket for medical care. Your choice of Health Professional and/or facility may result in lower or higher costs and you may be required to follow certain procedures to avoid additional costs. Your choice of Health Professional and/or facility, and wise use of these benefits, can savc you money. Within the Service Area, Members are entitled to receive the covered services and benefits through the AvMed Choice Network or from Out-of-Network Providers. Outside the AvMed Service Area, Members are entitled to receive the covered services and benefits either through the PHCS Network or through Out-of-Network Providers. See the Schedule of Benefits for applicable deductibles, Co-payments and Co-insurance levels. The AvMed Choice Plan creates three benefit payment levels; one for services provided by AvMed Choice providers, a second for services provided by PHCS providers and a third for services provided by Out-of- Network Providers. The Benefit Level this Group Plan will pay depends on the Health Professional and/or facility you select to provide covered health care services and where the services are received: . If the Health Professional and/or facility used is part of the A vMed Choice Network, benefits for covered services are payable at the Participating Provider high Benefit Level shown in the Schedule of Benefits. AV-CHOtCE-2009 MP-5320 (10/09) 21