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25C - AGMT GROUP INSURANCE
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25C - AGMT GROUP INSURANCE
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2/1/2018 7:02:12 PM
Creation date
2/1/2018 7:10:52 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Personnel Services
Item #
25C
Date
2/6/2018
Destruction Year
2023
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Orthodontic treatment is governed by the Orthodontic limitations listed on Your Schedule of Benefits. If You <br />terminate coverage from the plan after the start of Orthodontic treatment, You will be responsible for any <br />additional incurred charges for any remaining Orthodontic treatment. <br />Renewal Provisions <br />Your Organization has contracted with SafeGuard to provide services for the time period specified in the <br />group contract. Your coverage under the plan is guaranteed for that time period so long as You meet the <br />eligibility requirements under the plan. When the group contract expires, it may be renewed. If renewed, it Is <br />possible that the terms of the plan may have been changed. If changes to Covered Services, Co -payments <br />or Your contribution to the Prepayment Fees have been made to a renewed contract, Your Organization will <br />notify You not less than thirty (30) days before the effective date, <br />Reinstatement <br />Receipt by SafeGuard of the proper prepaid or periodic payment after cancellation of the contract for non- <br />payment shall reinstate the contract as though It had never been cancelled if such payment is received on or <br />before the due date of the succeeding payment. <br />A Member who alleges that his or her enrollment has been cancelled or not renewed because of his or her <br />health status or requirements for health care services may request a review by the Director of the California <br />Department of Managed Health Care. If the Director determines that a proper complaint exists, the Director <br />shall notify SafeGuard. Within fifteen (15) days after receipt of such notice, SafeGuard shall either request a <br />hearing or reinstate the person as a Member. If, after the hearing, the Director determines that the <br />cancellation or failure to renew is improper, the Director shall order SafeGuard to reinstate the person as a <br />Member. A reinstatement pursuant to this provision shall be retroactive to the time of cancellation or failure to <br />renew and SafeGuard shall be liable for the expenses incurred by the subscriber or enrollee for covered <br />health care services from the date of cancellation or non -renewal to and including the date of reinstatement. <br />Disenrollment <br />You may disenroll from the plan at the end of the term of the group contract, Please contact Your <br />Organization for more information. <br />CONTINUITY OF CARE <br />Current Members <br />If You are a current Member of SafeGuard, You may be eligible to temporarily continue receiving Covered <br />Services for You and/or Your dependents from a former Selected General Dentist Office or Specialty Care <br />Dentist whose contract with SafeGuard is terminated (a "Terminated Provider") for treatment of certain <br />specified dental conditions. Please call SafeGuard at (800) 880-1800 to see if You are eligible for this benefit. <br />You may request a copy of SafeGuard's Continuity of Care Policy from SafeGuard. You must make a specific <br />request to continue under the care of a Terminated Provider. SafeGuard is not required to continue Your care <br />with Your Terminated Provider if You are not eligible under SafeGuard's Continuity of Care Policy or if <br />SafeGuard cannot reach agreement with the Terminated Provider on the terms regarding Your and/or Your <br />dependents' care in accordance with California law. <br />New Members <br />If You are a new Member of SafeGuard, You may be eligible to temporarily continue receiving Covered <br />Services for You and Your dependents from an Out -of -Network Dentist for treatment of certain specified <br />conditions if the services were being provided by an Out -of -Network Dentist at the time the Your coverage <br />becomes effective. Please call SafeGuard at (800) 880-1800 to see If You may be eligible for this benefit. <br />You may request a copy of SafeGuard's Continuity of Care Policy from SafeGuard. You must make a specific <br />request to continue under the rare of the Out -of -Network Dentist. SafeGuard is not required to continue care <br />with the Out -of -Network Dentist if You are not eligible under SafeGuard's Continuity of Care Policy or if <br />SafeGuard cannot reach an agreement with the Out -of -Network Dentist on the terms regarding Your for You <br />and Your dependents care in accordance with California law. <br />GCERT2011-DHMO-EOC 25C-26 12 <br />
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