Res 1988-077 - Laserfiche WebLink

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Effective Date of Coverage The coverage of Enrollees and Eligible Dependents shall take effect on the later' of (1) the date this Cc"'ltf'act ta~.es effect, (2) 01'1 the fit'st day of the first month following the conclusion of the Initial Eligibility Pet'iod, C't' (3) .l\'Iless othet'wise specified in the Enrcll 1 irlg Unit's application, as fallows: ml-12-9 (1) If written application is made by an Enrollee and received by Health Plan after the date of coverage would have otherwise been effect i ve, covet'age shall take effect on the fit'st day of the fii'<;;t Cort;"a.=t !'I1.:;.:th f:JIIQwir-lg the dab? clf .:¡.ppr":lval by Health Pldn of such evidence of good health as it may require. (2) A newborn child of a Covered Person or Eligible Dependent is covered from birth, except that coverage terminates thirty-one (31) days aftet' birth unless the chi Id is enr'Jlled hereunder' arid all applicable charges and premiums are paid. Al'l adc'pted child is cl:)vet'ed f~"':'TI1 the date the child is acquit'ed by the adoptive parents except that the coverage terminates thirty-one (31) days after such acGuisition unless the child is enrolled hereunder. Coverage For ather newly acquired, Eligible Dependents shall take effect on the date such Eligible Dependent is legally acquired pr~vided the Health Plan is notified by the Enrollee within thirty-one (31) days. SECTION II I PROCEDURES FOR REIMBURSEMENT OF ELIGIBLE EXPENSES INCURRED WITH NON-PARTICIPATING PROVIDERS Notice of Claim Written nc,tice of Injury, Sickness, Maternity, Merit a 1 Illness or any ather condition for which individual claim may be made must be sent to Health Plan within thirty (30) days after the date of any service or supply for which Health Plan is liable hereunder, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Covered P~rson to Health Plan at its office in Austin, Texas, or t,;:, .:,!';Y .:'iuth(.,t'l;:ed ager:t I~f Health PLan with info'rrnatiol'l sufficient tl:, idEnt i fy tt1e C,Y,Ie>'f:rJ . Pet'50n! shall be ,:eemed to be rlQt ice t,:, Health Plan. Proofs of Loss Participating Providers are t'esponsible for submitting claims for Eligible Expenses directly to Health Plan on the Covered Person'5 behalf. In the event a Covered Person is billed by a Participating Provider for Eligible Expenses, the Covered Person should contact the Heal th Plal'!. Written proof of loss for any claim satisfactory to Health Plan must be furnished at its office within ninety (9Ø) days after the date Qf such loss. F¿ilure to Furnish such proof within the time required shall n~~ invalidate nor redu~e any claim if it was not reasQnably