CLAIM REMINDERS • BE SURE TO USE YOUR MEMBER ID AND ACCOUNT/GROUP NUMBER WHEN YOU FILE CLAIM FORMS, OR WHEN YOU CALL OUR CLAIM OFFICE. YOUR MEMBER ID IS THE ID SHOWN ON YOUR BENEFIT IDENTIFICATION CARD. YOUR ACCOUNT/GROUP NUMBER IS SHOWN ON YOUR BENEFIT IDENTIFICATION CARD. • BE SURE TO FOLLOW THE INSTRUCTIONS LISTED ON THE BACK OF THE CLAIM FORM CAREFULLY WHEN SUBMITTING A CLAIM TO US. Timely Filing Of Claims We will consider claims for coverage under Your plan when proof of loss (a claim) is submitted to Us within: • 12 months for both In-Network and Out-of-Network claims after services are rendered. If services are rendered on consecutive days, the limit will be counted from the last date of service. If claims are not submitted to Us within the timeframe shown above, the claim will not be considered valid and will be denied. Failure to give notice within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible. NOTE: Cigna considers one month to equal 30 days regardless of the number of days within a Calendar month. WARNING: Any person who knowingly and with intent to defraud any insurance company or other person: files an application for insurance or statement of claim containing any materially false information; or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act.
• You normally work at least 30 hours a week; and • You pay any required contribution. If you were previously insured and your insurance ceased because you were no longer employed, you must satisfy the New Employee Group Waiting Period to become insured again unless you are rehired within 12 months and met the New Employee Group Waiting Period in your previous employment. If your insurance ceased because you were no longer employed in a Class of Eligible Employees, you are not required to satisfy the 30-day Waiting Period if you again become a member of a Class of Eligible Employees. You will become eligible for insurance on the first of the month on or after the date you become a member of a Class of Eligible Employees. Eligibility Waiting Period – New Hire Your Eligibility Waiting Period is: • First of the month on or after 30 days of Active Service. If you are a rehire and have met the applicable 30 day waiting period during your previous employment, the waiting period will be waived upon rehire and you will be eligible the first of the month on or after your rehire date if you are rehired within 12 months. Effective Date of Your Insurance You will become insured on: • the date that: You are in Active Service and You elect the insurance by:
• authorizing premium payment, • approving a payroll deduction, or • signing an enrollment form, as applicable, but no earlier than the date You become eligible.
You will become insured on Your first day of eligibility, following Your election, if You are in Active Service on that date, or if You are not in Active Service on that date due to Your health status. Late Entrant You are a Late Entrant if: • You elect the insurance more than 31 days after You initially become eligible; or • You again elect it after You cancel Your payroll deduction (if required).
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Eligibility - Effective Date Eligible Class Each Employee as reported to Us by Your Employer. Eligibility for Dental Insurance You will become eligible for insurance on the day You complete the Eligibility Waiting Period, if any, and: • You are an eligible Full-Time Employee;
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