Prior Coverage Sample Clauses
The Prior Coverage clause defines how an insurance policy addresses claims or incidents that occurred before the current policy's effective date. Typically, this clause specifies whether and to what extent the insurer will provide coverage for losses arising from events that happened prior to the inception of the policy, often referencing previous policies or requiring continuous coverage. Its core practical function is to clarify the insurer's responsibility for past events, thereby preventing gaps in coverage and ensuring that policyholders are protected for claims related to earlier periods.
Prior Coverage. If a member is confined as an inpatient in a hospital on the effective date of this agreement, and prior coverage terminating immediately before the effective date of this agreement furnishes benefits for the hospitalization after the termination of prior coverage, then services and benefits will not be covered under this agreement for that member until the member is discharged from the hospital or benefits under the prior coverage are exhausted, whichever is earlier. If there is no prior coverage or no continuation of inpatient coverage after the effective date, your Ambetter of Illinois insured by Celtic Insurance Company coverage will apply for covered services related to the inpatient coverage after your effective date. Ambetter of Illinois insured by Celtic Insurance Company coverage requires you notify Ambetter of Illinois insured by Celtic Insurance Company within two days of your effective date so we can review and authorize medically necessary services. If services are at a non-contracted hospital, claims will be paid at the Ambetter of Illinois insured by Celtic Insurance Company allowed amount and you may be billed for any balance of costs above the Ambetter of Illinois insured by Celtic Insurance Company allowed amount.
Prior Coverage. (i) With respect to Litigation or other liabilities against a Party and its Representatives (such Party, an “Exposed Entity”) that are or may be, in the reasonable judgment of the Principal that is affiliated with such Exposed Entity, covered by insurance policies held by an unaffiliated Party or by indemnification otherwise available to an unaffiliated Party (a “Covered Entity”) in respect of periods prior to the Distribution Date (“Prior Coverage”), such Exposed Entity may pursue, or, to the extent possible, such Covered Entity shall be authorized to pursue, claims in respect of such Litigation or other liabilities on behalf of the Exposed Entity in the amounts and in accordance with the terms of such Prior Coverage, provided that such claims relate to matters that arose on or prior to the Distribution Date. Each Principal affiliated with a Covered Entity agrees that it will not, and will not permit any affiliate (including any Covered Entity) to, terminate any Prior Coverage without the other Principal’s consent. Promptly upon receipt of the proceeds of any such Prior Coverage resulting from such claims, the Covered Entity shall cause such proceeds to be paid to the Exposed Entity; provided that the amount of such proceeds paid by the Covered Entity to the Exposed Entity shall be, without duplication, (i) reduced by the amount of any fees and expenses reasonably incurred, or incurred with the Exposed Entity’s written consent, by the Covered Entity in pursuit of such claims, (ii) adjusted in good faith by the Covered Entity to reflect the present value of any increased fees and expenses associated with continuing to maintain the policy or indemnity from which the Prior Coverage arises that is attributable to the pursuit of such claim and (iii) adjusted in good faith by the Covered Entity to reflect any likely benefit to the Covered Entity attributable to the pursuit of such claim including, without limitation, any estimated benefits associated with the satisfaction of a deductible under any policy or indemnity providing the Prior Coverage.
(ii) Any Covered Entity pursuing a claim for Prior Coverage will, or will cause its affiliates to, diligently pursue all claims for Prior Coverage at the Exposed Entity’s expense, provided that in no event shall the Covered Entity be obligated to litigate or pursue any other extraordinary remedies against any insurer or indemnitor, except as provided in (iii) below. The Principals agree to consult in good faith with re...
Prior Coverage. If a member is confined as an inpatient in a hospital on the effective date of this agreement, and prior coverage terminating immediately before the effective date of this agreement furnishes benefits for the hospitalization after the termination of prior coverage, then services and benefits will not be covered under this agreement for that member until the member is discharged from the hospital or benefits under the prior coverage are exhausted, whichever is earlier. “
Prior Coverage. If a member is confined as an inpatient in a hospital on the effective date of this agreement, and prior coverage terminating immediately before the effective date of this agreement furnishes benefits for the hospitalization after the termination of prior coverage, then services and benefits will not be covered under this agreement for that member until the member is discharged from the hospital or benefits under the prior coverage are exhausted, whichever is earlier. Out of Service Area Dependent Member Coverage A dependent member’s coverage will not cease should the dependent member live outside the service area if a court order requires the member to cover such dependent member. There will be an open enrollment period for coverage on the Health Insurance Marketplace. The open enrollment period begins November 1, 2018 and extends through December 15, 2018. Qualified individuals who enroll on or before December 15, 2018 will have an effective date of coverage on January 1, 2019. The Health Insurance Marketplace may provide a coverage effective date for a qualified individual earlier than specified in the paragraphs above, provided that either:
Prior Coverage. There shall be no interruption of coverage as a result of the transition from the Prior Self-Insurance Agreement. The Member’s share of unexpended funds in the prior self-insurance agreement as of May 31, 1993, will be transferred by Metropolitan Library System (formerly Suburban Library System) to the Member’s share under this LIMRiCC agreement. The period of time of the member’s participation in the prior Self-Insurance Agreement shall be credited to the Member under this LIMRiCC agreement. (Article II- k.2)
Prior Coverage. During the last 5 years, the General Accounting Office (GAO) issued two reports discussing the Mentor Protégé Program. Unrestricted GAO reports can be accessed over the Internet at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇.
Prior Coverage. Send a HIPAA Certificate of Creditable Coverage to all covered enrollees whenever notified of a termination of coverage or when requested by the enrollee. The Certificate of Creditable Coverage will include information on coverage prior to this Agreement as supplied by the Plan Sponsor.