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In any event, we must receive the proof of loss not later than 15 months from the date of loss, unless you are not
legally competent to send it during that time.
Payment of Claim

We have the authority to automatically pay Benefits to Physicians or other providers. After we pay, we are
discharged from paying any further Benefits to the extent of what we already paid.
If you want to receive direct payment of Benefits, you must notify us before we receive proof of loss.

We may be required to pay Benefits to your estate, to your Dependent's estate, or to someone who is a minor or
is otherwise not legally competent. When this happens, we may pay an amount not to exceed $1,000 to a family
member who we believe is equitably entitled to that amount. Any payment we make in good faith fully discharges
Us, to the extent of that payment.

If we have documented proof that:
· A Physician or other provider waived from their total fees a Copayment, Annual Deductible or
Coinsurance amount that you are otherwise required to pay under the plan; then
· We have the right to reduce the benefit amount we pay by the amounts waived by the Physician or other
provider.

Time of Payment of Claim

We will pay or deny a claim when we receive a claim that includes all of the information needed to process the
claim subject to time review constraints under state law.

If additional supporting information is required to process the claim, we will notify the applicable person(s). This
notice will detail the supporting documentation needed.
As applicable, the provider or both you and the provider will be notified when a claim is denied. The notification
will include the reason(s) for the denial.
Assignment of Benefits

Except as described under the Payment of Claim provision, you cannot assign any other rights to another party.

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PPO - 2017