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.
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-POB132
01-19
HC-TRM128 M
12-17
Termination of Insurance
Rescissions Your coverage may not be rescinded (retroactively terminated) by Cigna or the plan sponsor unless the plan sponsor or an individual (or a person seeking coverage on behalf of the individual)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.
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. 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.
HC-TRM80
01-11
Federal Requirements The following pages explain your rights and responsibilities under federal laws and regulations. Some states may have similar requirements. If a similar provision appears elsewhere in this booklet, the provision which provides the better benefit will apply.
HC-FED1
10-10
53
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