Certificate of Coverage Sample Contracts
BLUE CROSS AND BLUE SHIELD OF TEXASCertificate of Coverage • September 20th, 2024
This Certificate of Coverage (“Certificate”) is part of the Group Agreement (“Group Agreement”) between the Group and Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation (HMO). The Group Agreement determines the terms and conditions of coverage. Provisions of this Certificate include the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any amendments, Riders, or attachments, which may be delivered with the Certificate or added later.
Certificate of CoverageCertificate of Coverage • September 2nd, 2021
This Contract (Certificate) is between the Subscriber who has executed an Application for Coverage and Alliant Health Plans, Inc. (hereinafter referred to as “Alliant Health Plans”, “Alliant” or “AHP”).
Certificate of CoverageCertificate of Coverage • November 20th, 2020
This Contract (Certificate) is between the Subscriber who has executed an Application for Coverage and Alliant Health Plans, Inc. (hereinafter referred to as “Alliant Health Plans”, “Alliant” or “AHP”).
BLUE CROSS AND BLUE SHIELD OF TEXASCertificate of Coverage • May 16th, 2022
This Certificate of Coverage (“Certificate”) is part of the Group Agreement (“Group Agreement”) between the Group and Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation (“HMO”). The Group Agreement determines the terms and conditions of coverage. Provisions of this Certificate include the Schedule of Copayments and Benefit Limits and any amendments, or attachments, which may be delivered with the Certificate or added later.
Aetna U.S. Healthcare Inc.Certificate of Coverage • February 4th, 2022
This Certificate of Coverage ("Certificate") is part of the Group Agreement ("Group Agreement") between Aetna U.S. Healthcare Inc., hereinafter referred to as HMO, and the Contract Holder. The Group Agreement determines the terms and conditions of coverage. The Certificate describes covered health care benefits. Provisions of this Certificate include the Schedule of Benefits, any riders, and any amendments endorsements, inserts, or attachments. Riders, amendments, endorsements, inserts or attachments may be delivered with the Certificate or added thereafter.
STATUTORY HOME OFFICE EXECUTIVE OFFICE ANNUITY SERVICE CENTER 2999 NORTH 44TH ST., STE 250 1 SUNAMERICA CENTER P. O. BOX 54299 PHOENIX, AZ 85018 LOS ANGELES, CA 90067-6022 LOS ANGELES, CA 90054-0299 AIG SUNAMERICA LIFE ASSURANCE COMPANY ("We", "Us",...Certificate of Coverage • April 19th, 2004 • Variable Separate Account of Anchor National Life Insur Co
CERTIFICATE OF COVERAGECertificate of Coverage • December 15th, 2016
This Contract (Certificate) is between the Subscriber who has executed an Application for Coverage and Alliant Health Plans, Inc. (hereinafter referred to as “Alliant Health Plans” or “AHP”)
INSURING AGREEMENTCertificate of Coverage • October 12th, 2021
The Nationwide Life Insurance Company has issued a Policy covering certain Eligible Classes of the Policyholder. The Benefits of the Policy are described in this Certificate and Your Schedule of Benefits.
Certificate of CoverageCertificate of Coverage • June 24th, 2022
This Contract (Certificate) is between the Subscriber who has executed an Application for Coverage and Alliant HealthPlans, Inc. (hereinafter referred to as “Alliant Health Plans,” “Alliant” or “AHP”)
Managed Dental Insurance Plan Certificate of CoverageCertificate of Coverage • September 3rd, 2020
This is your Certificate of Coverage, or certificate for short. It is one of three documents that together describe the benefits covered by your Aetna plan.
Total Health Care USA is a Qualified Health Plan issuer in the Health Insurance Marketplace.Certificate of Coverage • July 2nd, 2014
AETNA HEALTH INC. (GEORGIA)Certificate of Coverage • January 10th, 2014
This Certificate of Coverage ("Certificate") is part of the Group Agreement ("Group Agreement") between Aetna Health Inc., hereinafter referred to as HMO, and the Contract Holder. The Group Agreement determines the terms and conditions of coverage. Provisions of this Certificate include the Schedule of Benefits, and any amendments, riders or endorsements. Amendments, riders or endorsements may be delivered with the Certificate or added thereafter.
GROUP AGREEMENT COVER SHEETCertificate of Coverage • January 26th, 2010
AK30, AL30, AR31, AZ01, AZ30, CA01, CA02, CA04, CA05, CA30, CA31, CO01, CO31, FL02, FL03, FL04, FL31, GA01, GA04, GN03, HI30, IA30, IA31, ID30, IL02, IL03, IL31, IN04, IN32, KS30, KS31, LA01, LA31, ME01, MD01, MD02, MI01, MI31, MN30, MO33, MS30, MT30, NB30, NC29, NC30, ND30, NE01, NH01, NJ01, NM30, NV01, NV02, NV30, OH01, OH02, OH30, OH31, OK01, OK02, OK30, OR30, PA01, PA04, PA09, SC01, SD30, TN01, TN31, TX01, TX02, TX03, TX04, TX05, TX34, UT30, VA01, VA02, VA31, WA01, WA30, WI30, WY30
TOTA L LY T H E R E F O R YO UCertificate of Coverage • March 5th, 2014
Total Health Care USA is a nonprofit corporation organized and licensed under the laws of the State of Michigan, with its address at 3011 W. Grand Blvd., Suite 1600, Detroit MI 48202-3000.
Tax Topic: Certificate of CoverageCertificate of Coverage • October 29th, 2019
Are you a U.S. employer with operations in other foreign countries? Do you send employees to worh temporarily overseas? If so, you & your employees may benefit from the bilateral Social Security agreements the United States has concluded with certain foreign countries.
Form No. 002-OR90(1/19) Agreement No. 4500 Underwritten by Willamette Dental Insurance, Inc.Certificate of Coverage • July 7th, 2011
Please utilize the following contact information for questions or assistance. Members who wish to schedule an appointment may do so by contacting our Appointment Center. Willamette Dental Group has a full staff of member service representatives who will answer any question that you may have about your dental plan or service.
INSURING AGREEMENTCertificate of Coverage • January 14th, 2013
Final interpretation is governed by the Policy. You may review the Policy at the Policyholder’s address during normal business hours. This Certificate replaces any and all Certificates previously issued for the eligible classes under the Policy. This Certificate describes the Policy in detail.