Dialysis Savings & Support
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SCHEDULE OF MEDICAL BENEFITS
| Outpatient Dialysis Treatment | 100% of the lesser of (i) the Usual, Customary, and Reasonable Outpatient Dialysis Charge as defined below, (ii) the maximum allowable charge after all applicable deductibles and cost-sharing; and (iii) such charge as is negotiated between the Plan Administrator and the provider of Outpatient Dialysis Treatment. |
Outpatient Dialysis Treatment. When used in this document, the term “Outpatient Dialysis Treatment” shall mean any and all products, services, and/or supplies provided to Plan members/participants/beneficiaries for purposes of, or related to, outpatient dialysis.
DISCRETIONARY AUTHORITY
The Plan Administrator shall perform its duties as the Plan Administrator and in its sole discretion shall determine appropriate courses of action in light of the reason and purpose for which this Plan is established and maintained. In particular, the Plan Administrator shall have full and sole discretionary authority to interpret all plan documents and to make all interpretive and factual determinations as to whether any individual is entitled to receive any benefit under the terms of this Plan. Any construction of the terms of any plan document and any determination of fact adopted by the Plan Administrator shall be final and legally binding on all parties. To the extent permitted by law, the Plan Administrator shall have the discretionary authority to rely conclusively upon all tables, valuations, certificates, opinions and reports which are furnished by accountants, counsel or other experts employed or engaged by the Plan Administrator.
Assignments
No benefit, right or interest of any member under the Plan shall be subject to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, charge, garnishment, execution or levy of any kind, either voluntary or involuntary, including any liability for, or subject to, the debts, liabilities or other obligations of such person. Any attempt to anticipate, alienate, sell, transfer, assign, pledge, encumber, charge, garnish, execute or levy upon, or otherwise dispose of any right to benefit payable hereunder or legal causes of action, shall be void. Notwithstanding the foregoing, the Plan may choose to remit payments directly to providers with respect to covered benefits, if authorized by the member, but only as a convenience to the member. Providers are not, and shall not be construed as, “participants,” “beneficiaries” or “claimants” under this Plan and have no rights to receive benefits from the Plan or to pursue legal causes of action on behalf of (or in place of) participants under any circumstances.