X hits on this document





80 / 113

General Conditions

Covered Expense Covered expense is considered to have been incurred on the date the service is received or rendered.

Benefits for covered expenses will be provided only to the extent that the provider can render such service, and payment therefore to the provider by Blue Cross & Blue Shield or Catalyst Rx as herein provided will constitute a complete discharge of the obligation of the Plan hereunder.

The Plan does not insure against any condition, disease, ailment, or injury (including pregnancy and conditions arising from it), but only provides benefits for covered expenses incurred by a Plan participant during his effective dates of coverage under the Plan.

Liability Neither the Plan Sponsor nor its contractors, their agents, or their employees will be liable for or on account of any fault, act, omission, negligence, misfeasance, malfeasance, or malpractice on the part of any hospital or other institution, any agent, or employee thereof, or on the part of any physician, health care professional, pharmacist, or other person participating in or having to do with the care or treatment of the Plan participant.

Notices Any notice required to be given by a contractor of the Plan Sponsor to an enrollee hereunder will be deemed to be given and delivered when deposited in the United States mail, postage prepaid, addressed to the enrollee at his address as the same appears on the records of Blue Cross & Blue Shield.

Proof of Loss Upon failure of the Plan participant to notify Blue Cross & Blue Shield or Catalyst Rx or furnish proof of loss, payment may be refused or a percentage of the regular payment may be paid at the option of the Plan; provided, however, failure to give notice of proof of loss within the time provided will not invalidate a claim if it can be shown that compliance with this provision was not reasonably possible and that notice of claim was given as soon as reasonably possible.

Breach or Default Whenever any condition or requirement of the Plan has been breached by the Plan participant or he is in default as to any term or condition hereof, failure of the Plan Sponsor, Blue Cross & Blue Shield, Intracorp, or Catalyst Rx to avail of any right stemming from such breach or default, or indulgences granted, will not be construed as a waiver of the right of the Plan Sponsor, Blue Cross & Blue Shield, Intracorp, or Catalyst Rx on account of existing or subsequent such breach or default.


Document info
Document views138
Page views138
Page last viewedSun Oct 23 21:00:23 UTC 2016