If any person to whom benefits are payable is a minor or, in the opinion of Cigna is not able to give a valid receipt for any payment due him, such payment will be made to his legal guardian. If no request for payment has been made by his legal guardian, Cigna may, at its option, make payment to the person or institution appearing to have assumed his custody and support. When one of our participants passes away, Cigna may receive notice that an executor of the estate has been established. The executor has the same rights as our insured and benefit payments for unassigned claims should be made payable to the executor. Payment as described above will release Cigna from all liability to the extent of any payment made. Recovery of Overpayment When an overpayment has been made by Cigna, Cigna will have the right at any time to: recover that overpayment from the person to whom or on whose behalf it was made; or offset the amount of that overpayment from a future claim payment. In addition, your acceptance of benefits under this plan and/or assignment of Medical Benefits separately creates an equitable lien by agreement pursuant to which Cigna may seek recovery of any overpayment. You agree that Cigna, in seeking recovery of any overpayment as a contractual right or as an equitable lien by agreement, may pursue the general assets of the person or entity to whom or on whose behalf the overpayment was made. Calculation of Covered Expenses Cigna, in its discretion, will calculate Covered Expenses following evaluation and validation of all provider billings in accordance with: the methodologies in the most recent edition of the Current Procedural terminology. the methodologies as reported by generally recognized professionals or publications.
the date the policy is cancelled. the last day of the calendar month in which your Active Service ends except as described below. Any continuation of insurance must be based on a plan which precludes individual selection. Temporary Layoff or Leave of Absence If your Active Service ends due to temporary layoff or leave of absence, your insurance will be continued until the date as determined by your Employer. Injury or Sickness If your Active Service ends due to an Injury or Sickness, your insurance will be continued while you remain totally and continuously disabled as a result of the Injury or Sickness. However, your insurance will not continue past the date your Employer cancels your insurance. Dependents Your insurance for all of your Dependents will cease on the earliest date below: the date your insurance ceases. the date you cease to be eligible for Dependent Insurance. the last day for which you have made any required contribution for the insurance. the date Dependent Insurance is cancelled. The insurance for any one of your Dependents will cease on the last day of the calendar month of which the date that Dependent no longer qualifies as a Dependent. .
HC-TRM128 M
12-17
Rescissions Your coverage may not be rescinded (retroactively terminated) by Cigna or the plan sponsor unless the plan sponsor or an individual (or a person seeking coverage on behalf of the individual) performs an act, practice or omission that constitutes fraud; or the plan sponsor or individual (or a person seeking coverage on behalf of the individual) makes an intentional misrepresentation of material fact.
HC-POB132
01-19
Termination of Insurance
Employees Your insurance will cease on the earliest date below: the last day of the calendar month in which you cease to be in a Class of Eligible Employees or cease to qualify for the insurance. the last day of the calendar month in which you have made any required contribution for the insurance.
HC-TRM80
01-11
53
myCigna.com
Made with FlippingBook Online newsletter