Reso 2010-1529 - Laserfiche WebLink

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t") ) o ) ) 16.03 Certificate of Coverage. AvMed shall provide a copy of the Certificate of Coverage for each Subscriber. No changes or amendments to this Contract shall be valid unless approved by an executive officer of AvMed and endorsed herein or attached hereto. No agent has authority to change this Contract or to waive any of its provisions. 16.04 Circnmstances not reasonably within the control of AvMed. In the event of circumstances not reasonably within the control of AvMed, including major disasters and under such circumstances as complete Of partial destruction of facilities, an act of God, war, riot, civil insurrection, disability of a significant part of Hospital or participating medical personnel or similar causes, if the rendition of Medical Services and Hospital Services provided under this Contract is delayed or rendered impractical, neither AvMed, Participating Providers, nor any physician shall have any liability or obligation on account of such delay or failure to provide services; however, AvMed shall make a good faith effort to arrange for the timely provision of covered services during such event. 16.05 Clerical errors. Clerical errors shall neither deprive any individual Member of any benefits or coverage provided under this Group Contract nor shall such errors act as authorization of benefits or coverage for the Member that is not otherwise validly in force. Retroactive adjustments in coverage, for clerical errors or otherwise will only be done for up to a 60 day period from the date of notification. Refunds of premiums are done for up to a 60 day period from the date of notification. Refunds of premiums are limited to a total of 60 days from the date of notification of the event, provided there are no Claims incurred subsequent to the effective date of such event. 16.06 Contracting parties. By execnting this Contract, Subscribing Group and AvMed agree to make the Medical Services and Hospital Services specified herein available to persons who are eligible under the provisions of Part IV. However, the delivery of benefits and services covered in this Contract shall be subject to the provisions, Limitations, and Exclusions set forth herein and any amendments, modifications, and Contract termination provisions specified herein and by the mutual agreement between Av Med and Subscribing Group, without the consent or concurrence of the Members. By electing or accepting Medical Services and Hospital or other benefits hereunder, all Members legally capable of contracting and the legal representatives of all Members incapable of contracting, agree to all terms, conditions, and provisions hereof. 16.07 Contract review. Subscribing Group may, if this Contract is not satisfactory for any reason, return this Contract within three days after receipt and receive a full refund of the deposit paid, if any, unless the services of AvMed were utilized during the three days. If this Contract is not returned within three days after receipt, then this Contract shall be deemed to have been accepted. 16.08 Entirety of Contract. This Agreement and all applicable schedul~s, exhibits, riders, amendments and any other attachments and endorsements, constitute the entire Contract between the Subscribing Group and AvMed. No modification (or oral representation) of this Group Contract shall be of any force or effect unless it is in writing and signed by both parties. 16.09 ERISA. When this Contract is purchased by the Subscribing Group to provide benefits under a welfare plan governed by ERISA, AvMed shall bc considered a fiduciary to the extent that it perfornls any discretionary functions on behalfofthe Plan. lfa Member has questions about the group's welfare plan, the Member should contact the Subscribing Group. 16.10 Gender. Whenever used, the singular shall include the plural and the plural the singular and the use of any gender shall include all genders. "16.11 Identification cards. Cards issued by AvMed to Members pursuant to this Contract are for purposes of identification only. Possession of an AvMed identification card confers no right to health services or other benefits under this Contract. To be entitled to such services or benefits the holder of the card must, in fact, be a Member on whose behalf all applicable charges under this Contract have actually been paid and accepted by AvMed. 48 A V-CHOICE-2009 MP-5320 (10/09)