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(a) Excess insurance is provided under this Certificate; and <br />(b) The Covered Person has coverage under another plan providing medical expense benefits; and <br />(c) The other plan is an HMO, PPO or similar arrangement ("PPO-Preferred Provider Organization" means <br />an Organization offering health care services through designated health care providers who agree to <br />perform these services at rates lower than nonpreferred providers.); and <br />(d) The Covered Person does not use the facilities or services of the HMO, PPO or similar arrangement for <br />the provision of benefits. <br />'The Covered Person's limitation does not apply to emergency treatment required within 24 hours after an <br />Accident which occurred outside the geographic area serviced by the HMO, PPO or similar arrangement. <br />(2) Costs that exceed the Usual, Reasonable and Customary charges in the area where the services are <br />furnished or supplies provided. Services, supplies and equipment must be: <br />a) Medically necessary for the care or treatment of a covered Injury; <br />b) Received while coverage is in force under this Certificate; and <br />c) Rendered and/or prescribed by a licensed Doctor other than the Covered Person (or a member of his <br />household or immediate family) in accordance with current medical standards and practices. <br />(3) The application of the Coordination of Benefits or Non -Duplication of Benefits provision. <br />(4) If the Covered Person is admitted into the Hospital on a Friday or a Saturday on a non -emergency basis and <br />the procedure for which he is admitted is not performed on the day of or the day after admission, we will not <br />pay the Hospital charges for room and board or miscellaneous Hospital charges for the initial Friday or <br />Saturday preceding the procedure. <br />PREMIUM PROVISIONS <br />GRACE PERIOD: <br />A grace period of 31-days is granted for each premium due after the first premium due date. Coverage will stay in <br />force during this period unless notice has been sent, in accordance with the POLICY TERMINATION provision, of <br />the intent to terminate coverage under this Certificate. Coverage will end if the premium is not paid by the and of <br />the grace period. <br />PREMIUMS: <br />Premium due dates are the first of every month. Premium payment made in advance or for more than a one <br />month period will not affect any provisions of this Certificate with regard to change. Failure by the <br />Certificateholder to pay premiums when due or within the grace period shall be deemed notice to us to terminate <br />coverage at the end of the period for which premium was paid. <br />CHANGES IN RATES: <br />We have the right to change the premium rates on any premium due date: <br />(1) After the first 12 months Insurance is in effect; <br />(2) Coinciding with a change in the coverage provided or classes eligible; or <br />(3) Coinciding with a change in the risks we have assumed. <br />We will give 31 days written notice of any change under (1) above. Notice will be sent to the Certificateholder's <br />most recent address in our records. <br />GENERAL PROVISIONS <br />ENTIRE CONTRACT; CHANGES: <br />GAC26932 <br />