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Atlantis Health Plan Member Handbook- POS

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Benefit Coverage

Timely payment of premiums is required in order to continue health care coverage and benefits. The Plan may terminate coverage and benefits based on non-payment of premiums as defined in the Subscriber Contract and/or Group Remittance Agreement.

Coordination of Benefits for Group Members

If you are covered under any other health insurance plan, tell your doctor and AHP. Any time more than one Group health insurance policy is effective for an individual, the insurance companies must coordinate their payments to ensure all covered services are paid, and that the combined payments do not exceed the charges for the services rendered.

The rules that determine which insurance carrier is primary or secondary are standard in the insurance industry. However, all AHP procedures must be followed in order for AHP to assume payment, even if AHP coverage is not primary. Therefore, remember to see your Primary Care Provider for referrals to participating AHP providers. Should you have questions about Coordination of Benefits after carefully reading the information in your Subscriber Contract, please call the AHP Member Services Department at 1-866-747-8422.

Termination of Coverage

Your coverage and/or the coverage of your dependents may terminate for the following reasons:

  • If your premium is not paid per contractual terms.
  • If you move outside the service area (unless you continue to work in the area and receive all of your covered health care within the AHP service area).
  • If you use your AHP ID card in a fraudulent manner.
  • If an employer provides your group coverage and you leave the company.
  • If you decide to cancel the contract with AHP or the group remittance agreement is canceled by the remitting agent.
  • If AHP decides to discontinue this class of HMO contract.
Coverage for dependents and/or your spouse will end:
  • If your marriage is terminated, coverage for your spouse will end on the date of your divorce or annulment.
  • If a dependent ceases to meet eligible age requirements, coverage will end on the last day of the month in which the qualifying age was met.

Continuation of Group Coverage

Should you or your dependents become ineligible for coverage through your current group, you may be able to continue the coverage if you qualify as required by the Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) or the laws of the State of New York. Please contact your employer for further details of this and other applicable laws.

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