Assignment of Benefits Sample Clauses

Assignment of Benefits. Neither the Participant nor any other beneficiary under the Plan shall have any right to assign the right to receive any benefits hereunder, and in the event of any attempted assignment or transfer, the Company shall have no further liability hereunder.

Assignment of Benefits. All rights of the Member to receive benefits hereunder are personal to the

Assignment of Benefits. You may assign Benefits provided for Covered Services only to the Provider rendering services. You may not assign this Agreement to anyone else without our written permission.

Assignment of Benefits. Where the insurer has paid expenses or benefits to you or on your behalf under this policy, the insurer has the right to recover, at its own expense, those payments from any applicable source or any insurance policy or plan that provides the same benefits or recoveries. This policy also allows the insurer to receive, endorse and negotiate eligible payments from those parties on your behalf. When the insurer receives payment from any other insurer, or any other source of recovery to the insurer, the respective payor is released.

Assignment of Benefits. I hereby authorize and assign all payments and/or insurance benefits for medical services rendered to me directly to Women’s Health Associates of Southern Nevada. I hereby authorize Women’s Health Associates of Southern Nevada to release medical information necessary to obtain payment for services rendered by providers of Women’s Health Associates of Southern Nevada. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND FULLY UNDERSTAND IN ITS ENTIRETY, THE INFORMATION IN THIS FINANCIAL POLICY AGREEMENT. I UNDERSTAND THAT BY SIGNING THIS FINANCIAL POLICY AGREEMENT, I AM AGREEING TO THE TERMS AND CONDITIONS PROVIDED WITHIN THIS AGREEMENT. / / Patient Name Date of Birth / / Patient/Health Care Agent/Guardian/Relative Signature Date Name: DOB: / / PCP: DATE: / / _ Anxiety/Depression □ Yes □ No Last pap smear: □ Normal □ Abnormal Anemia □ Yes □ No Last mammo: □ Normal □ Abnormal Asthma/Lung condition □ Yes □ No Last colonoscopy: □ Normal □ Abnormal Arthritis □ Yes □ No Last DEXA (bone) scan: □ Normal □ Abnormal Bleeding disorder □ Yes □ No Previous treatment for abnormal pap smears? Bowel problems □ Yes □ No □ Colpo □ Cryo □ LEEP □ Conization □ N/A Cancer: Last menstrual period: Diabetes □ Yes □ No Age of first period: Elevated cholesterol □ Yes □ No Periods occur every days and last days Endometriosis/PCOS □ Yes □ No □ Heavy □ Clots □ Pain □ Cramping □ Irregular bleeding Heart disease □ Yes □ No Average # of pads/tampons used per day: High blood pressure □ Yes □ No Menopausal: □ Yes □ No Age began: Headaches □ Yes □ No Hysterectomy: □ Yes □ No When? Kidney disease/stones □ Yes □ No Complaints of: □ Breast pain □ Infertility □ Fibroids □ Ovarian cysts Liver disease/Hepatitis □ Yes □ No □ Pain w/ intercourse □ Vaginal infections □ Leaking of urine Stroke □ Yes □ No Have you ever been diagnosed with any of the following: Thyroid disorder □ Yes □ No Gonorrhea □ Yes □ No Other: Chlamydia □ Yes □ No SOCIAL HISTORY Herpes (Genital) □ Yes □ No Married/Single/Divorced/Widowed/Separated HPV/Genital warts □ Yes □ No Smoke: □ Yes □ No Packs per day: Hepatitis B or C □ Yes □ No Alcohol: □ Yes □ No How much? HIV □ Yes □ No Street drugs: Syphilis □ Yes □ No Marijuana: □ Medical □ Recreational Number of sexual partners (in lifetime): Sexual preference: Current birth control method: Number of Miscarriages: Abortions: Ectopic: Live Births: Ablation Date: Breast surgery Date: D&C Date: Hysterectomy Date: Laparoscopy Date: Ovaries removed Date: Tubal ligation D...

Assignment of Benefits. The pensions and other benefits provided under the terms of the Plan are not capable of assignment or alienation and do not confer upon any member, personal representative or dependent, or any other person, any right or interest in the pensions and other benefits capable of being assigned or otherwise alienated.

Assignment of Benefits. You may not assign your Benefits under this Policy or any cause of action related to your Benefits under this Policy to an out-of-Network provider without our consent. When an assignment is not obtained, we will send the reimbursement directly to the Policyholder for reimbursement to an out-of-Network provider. We may, as we determine, pay an out-of- Network provider directly for services rendered to you. In the case of any such assignment of Benefits or payment to an out-of-Network provider, we have the right to offset Benefits to be paid to the provider by any amounts that the provider owes us. When you assign your Benefits under this Policy to an out-of-Network provider with our consent, and the out-of- Network provider submits a claim for payment, you and the out-of-Network provider represent and warrant the following: • The Covered Health Care Services were actually provided. • The Covered Health Care Services were medically appropriate. • Allowed Amounts due to an out-of-Network provider for Covered Health Care Services that are subject to the No Surprises Act of the Consolidated Appropriations Act (P.L. 116-260) are paid directly to the provider. SAMPLE Payment of Benefits under the Policy shall be in cash or cash equivalents, or in a form of other consideration that we determine to be adequate. Where Benefits are payable directly to a provider, such adequate consideration includes the forgiveness in whole or in part of the amount the provider owes us, or to other plans for which we make payments where we have taken an assignment of the other plans' recovery rights for value.

Assignment of Benefits. We will pay for medical expenses directly to a licensed health care provider if the insured gives us a signed written assignment of benefits payable under PART B > MEDICAL PAYMENTS COVERAGE. If we pay benefits directly to a health care provider, we have no further duty or liability to pay those same benefits to an insured or to any other person or entity.

Assignment of Benefits. ‌ You may not in any way, assign or transfer your rights or benefits under this Contract. In addition, you may not, in any way, assign or transfer your right to pursue any causes of action arising under this Contract including, but not limited to, causes of action for denial of benefits under this Contract. ENROLLMENT PAYMENTS‌ Coverage under this Contract is conditioned on our regular receipt of payments for all enrollees. Enrollment payments are based upon the contract type and the number and status of any dependents enrolled with the enrollee. Enrollment payments do not take into account the claim experience or any change in health status of the enrollee, which occurs after the initial issuance of this Contract. Your enrollment payments usually change annually on your Renewal Date (which may be different than your effective date), subject to 30 days notice. Your enrollment payments may change during the year if you add ▇▇ terminate coverage for any dependents. We will bill you for your pre-payment on a monthly cycle. BENEFITS‌ This Contract provides comprehensive Network Benefits (Network Benefits) underwritten by GHI, when you seek medical and dental services delivered by participating network providers or authorized by us. This Contract describes your Network Benefits and how to obtain covered services. This Contract also provides Non-Network Medical Expense Benefits (Non-Network Benefits), underwritten by HealthPartners Insurance Company, for medical and dental services delivered by non-network providers. This coverage is in addition to your comprehensive network coverage under this Contract. It is not used to fulfill the comprehensive HMO coverage required by law. This Contract describes your Non-Network Benefits and how to obtain covered services. Pediatric services will be covered until at least the end of the month in which the member turns 19. If you are insured under this Contract you may have access to certain additional benefits and discounts offered by or through an arrangement with HealthPartners from time to time. BENEFITS CHART‌ Attached to this Contract is a Benefits Chart, which is incorporated and fully made a part of this Contract. It describes the amounts of payments and limits for the coverage provided under this Contract. Refer to your Benefits Chart for the amount of coverage applicable to a particular benefit. CHANGES IN BENEFITS‌ We are permitted to change benefits under this Contract to maintain compliance with federal and state la...