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General Provisions
A. Assignment of Benefits
Member rights to receive benefits under the Group Contract are personal and may not be assigned.
B. Changes to Contract
Atlantis Health Plan may change the provisions of this Certificate of Coverage. Such changes will be approved by the appropriate State regulatory agencies. Subscribers and Policyholders will receive at least 60 days prior written notice of changes. All unilateral modifications of coverage will be effective on the Contract Renewal Date.
C. Construction of Contract
Atlantis Health Plan will have authority to determine eligibility for benefits and to interpret the terms of the Contract.
D. Governing Agreement
The rights and responsibilities of Members are defined in the Subscriber Certificate of Coverage and should any discrepancy occur between the Subscriber Certificate of Coverage and any other Plan literature, the Subscriber Certificate of Coverage is the governing Agreement.
E. Identification Card
The Identification Card issued by Atlantis Health Plan does not entitle Members to services or benefits. To be eligible for services and benefits, the cardholder must be a Member, in good standing, on whose behalf all applicable premiums have been paid.
If a Member willingly permits his or her Atlantis Health Plan ID card to be used by another person, the card will be revoked by the Plan and the Member’s coverage will be terminated. The Member will be financially responsible for all claims generated through the fraudulent use of his or her ID card. Similarly, if a Member uses his own card after his or her enrollment has terminated, the Member will be responsible for all costs generated by use of the card.
F. Independent Contractor Relationship
No Participating Provider or other provider, institution, facility or agency is an agent or employee of Atlantis Health Plan. Participating providers maintain the physician-patient relationship with Members. They are solely responsible for all medical services that are provided to Members.
G. Legal Actions
Lawsuits and legal actions against the Plan for payment of claims must be brought within two years of the date of service.
H. Limitation on Services
Except in cases of emergency and certain specialty care services as defined in this Certificate of Coverage, services are available only from participating providers.