HomeMy WebLinkAboutCAG1997-0043 - Other - Group Health Cooperative - Group Medical Coverage Agreement - 01/01/1997 - Contract Revision GROUP HEALTH COOPERATIVE OF PUGET SOUND
CONTRACT REVISIONS
Effective 1/1/97
CONTRACT
LANGUAGE/BENEFIT CHANGE EXPLANATION
Signature Page New Contract Officer Signature/Title
Edward M.Denning,Senior Director
Service Area The definition of Service Area has been
revised to include Mason County(see
Section I.).
COBRA Section IV.has been revised in accordance
with the 1997 Federal COBRA regulations.
Enrollment and Eligibility Schedule Section IX.B.has been revised and reads as
follows: Temporary Coverage for Ineligible
Newborns. A child born to a covered
Member which does not otherwise qualify
as an eligible dependent as set forth in this
section will be entitled to the benefits set
forth in Section X.from birth through three
(3)weeks of age. After three(3)weeks of
age,no benefits are available unless the
newborn child qualifies as a Dependent
and is enrolled under this Agreement. All
contract provisions,limitations,and
exclusions will apply except Section IV
Continuation of Coverage, Conversion,and
Transfer.
In regard to temporary coverage,
continuation of coverage benefits set forth
in Section IV.will not apply.
This is a clarification in the basic contract:
Subscribers and covered dependents who
are eligible for Medicare(as set forth below)
must,effective the date that Medicare
becomes primary payor,enroll in Medicare
Parts A&B,and must participate in GHC's
Medicare Plan.For purposes of this section,
an individual shall be deemed eligible for
Medicare when he or she has the option to
receive part A Medicare benefits,
irrespective of whether the individual elects
to enroll in Part B coverage under the
Federal regulations.
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Smoking Cessation A clarification has been made to denote that
the Smoking Cessation Program addressees
other forms of tobacco.
Certificate of Coverage The detailed description of benefits(benefit
grid)available to those Members that are
Medicare-eligible and still covered under a
group contract changed in location. This
change in location was prompted by
numerous concerns and questions regarding
the location of this grid(and questioning of
benefits).
General Information For Administrative purposes some
provisions have been moved to a more
appropriate location.
Business and Insurance Services Business and Insurance Services and the
Information and Service Line have been
combined.The new name is Group Health
Customer Service Center and the new phone
numbers are 901-4636 or 1-888-901-4636
for general information and 9014600 or
1-888-901-4600 for Medicare information.
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