In the event We fail to pay benefits when due, the person entitled to such benefits may bring action to recover such benefits, any interest which may accrue as provided in subparagraph 3 of this paragraph (h) and any other damages as may be allowable by law. If it is determined in such action that We acted in bad faith as evidenced by a repeated or deliberate pattern of failing to pay benefits and/or claims when due, the person entitled to such benefits (health care provider or insured) shall be entitled to recover damages in an amount up to three (3) times the amount of the benefits that remain unpaid until the claim is finally settled or adjudicated.
b) Physician Examination and Autopsy is replaced by the following:
Physical Examination While a claim is pending, We have the right at Our expense to have the Covered Person who has a loss examined by a Physician when and as often as We reasonably require.
3) Under the Administrative Provision section, the Change in Premium Rates provision is replaced with the following:
The premium rates may be changed by Us from time to time with at least 60 days advance written notice.
4) Under the General Provisions section, Misstatement of Age or Sex provision is replaced by the following:
Misstatement of Age If the Covered Person’s age has been misstated, the benefits payable under this Policy shall be as such as the premium paid would have purchased had such fact been correctly stated.
New Hampshire residents:
1) The Schedule of Benefits is modified as follows:
a) The Benefit Waiting Period will not apply.
b) The Hospitalization Benefits are revised as follows:
i) Elimination Periods do not apply ii) A $50 per day minimum benefit is payable even if Age Based Reductions apply. iii) For Hospital Stay, Hospital Intensive Care Unit Stay and Newborn Nursery Care Stay, if included, up to 31 days of benefits are available. iii) All references to “Treatment” are replaced with “Visit” for the Additional Inpatient and Outpatient Care Benefits iv) Prescription Drug Benefit will pay Generic and Mail Order at the Brand-Retail benefit amounts
2) Under the General Definitions section, the following changes are made:
a) The definition of Covered Accident is revised to remove ''external'' event.
b) The definition of Dependent Child is replaced with the following:
An Employee’s child who meets the following requirements:
1. A child by blood or by law ho is under age 26 years old; 2. A child who is 26 or more years old, primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap.
A child, for purposes of this provision, includes an Employee’s: 1. natural child;
35
Made with FlippingBook - PDF hosting