Timely Filing of Out-of-Network Claims Cigna will consider claims for coverage under our plans when proof of loss (a claim) is submitted within 180 days for Out- of-Network benefits after services are rendered. If services are rendered on consecutive days, such as for a Hospital Confinement, the limit will be counted from the last date of service. If claims are not submitted within 180 days for Out- of-Network benefits, the claim will not be considered valid and will be denied. 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.
Waiting Period First of the Month on or after 30 days of active service. Classes of Eligible Employees Each Employee as reported to the insurance company by your Employer. Effective Date of Employee Insurance You will become insured on the date you elect the insurance by completing the Employer’s specified enrollment process, 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 - Employee You are a Late Entrant if: you elect the insurance more than 31days after you become eligible; or you again elect it after you cancel your payroll deduction (if required). Dependent Insurance For your Dependents to be insured, you will have to pay the required contribution, if any, toward the cost of Dependent Insurance. Effective Date of Dependent Insurance Insurance for your Dependents will become effective on the date you elect it by completing the Employer’s specified enrollment process, but no earlier than the day you become eligible for Dependent Insurance. All of your Dependents as defined will be included. Your Dependents will be insured only if you are insured. Late Entrant – Dependent You are a Late Entrant for Dependent Insurance if: you elect that insurance more than 31 days after you become eligible for it; or you again elect it after you cancel your payroll deduction (if required). Exception for Newborns Any Dependent child born while you are insured will become insured on the date of his birth if you elect Dependent Insurance no later than 31 days after his birth. If you do not elect to insure your newborn child within such 31 days, coverage for that child will end on the 31st day. No benefits for expenses incurred beyond the 31st day will be payable.
HC-CLM25
01-11
V11
Eligibility - Effective Date
Employee Insurance This plan is offered to you as an Employee. Eligibility for Employee Insurance You will become eligible for insurance on the day you complete the waiting period if: you are in a Class of Eligible Employees; and you are an eligible, full-time Employee; and you normally work at least 30 hours a week; and you pay any required contribution. If you were previously insured and your insurance ceased, you must satisfy the New Employee Group Waiting Period to become insured again. Initial Employee Group: You are in the Initial Employee Group if you are employed in a class of employees on the date that class of employees becomes a Class of Eligible Employees as determined by your Employer. New Employee Group: You are in the New Employee Group if you are not in the Initial Employee Group Eligibility for Dependent Insurance Insurance for your Dependents will become effective on the date you elect it by completing the Employer’s specified enrollment process, but no earlier than the day you become eligible for Dependent Insurance.
the day you become eligible for yourself; or the day you acquire your first Dependent.
HC-ELG274 M
01-19
11
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