The plan certifies that a Member is eligible for benefits provided by ntiDirectCare and subject to all provisions, definitions, limitations and conditions of the plan. Member is eligible for benefits listed on Member fee schedules through the expiration date listed on the ID card.
The address of the principal administration office of ntiDirectCare (hereinafter referred to as “Plan”) is:
ntiGroup, 2250 Erin Court, Lancaster, Pennsylvania 17601. The telephone number is 717-397-1171.
Part I. Definitions
A. Dependent shall mean lawful spouse of Member and/or unmarried natural, step or adopted children, or children under legal guardianship up to his/her 26th birthday Dependent may also include a Domestic Partner and/or children of a Domestic Partner.
B. Domestic Partner shall mean a person who is at least 18 years old, is not related by blood or marriage and has been financially interdependent with Member.
C. Member shall mean any individual that possesses an ntiDirectCare ID card from purchase or issued free.
D. Participating Provider shall mean those providers who have contracted with the Plan to provide services for members and dependents of the Plan. Participating Providers are not employees of, nor supervised by the Plan.
E. Premiums shall mean amounts payable by the Member to the Plan.
F. Member Fee Schedule shall mean those fees that the Participating Providers will accept for services.
Part II. Effective Date of Benefits
A. All Members who have enrolled in and have paid appropriate premiums on or before the first day of the month shall be eligible for benefits on the first day of that month.
B. All Dependents become eligible for services the day a Member is eligible.
Part III. Termination or Cancellation
Benefits shall cease upon the earliest of the following events:
A. On the date of expiration of the period for which the last premium payment was made to the Plan. A grace period of 31 days from the due date shall be granted to the Member for payment.
B. Upon the date of Dependents attaining the age of 26 years.
C. Upon breach of any term or condition herein, fraud or deception in the use of services, coverage will be cancelled the 7th day after the notice has been mailed.
Part IV. Premiums and Member Fees
A. Monthly premiums are payable on or before the 1st day or the month in which services may be rendered.
B. Monthly premiums must be debited from either a bank or credit card account.
Part V. Reinstatement
If any renewal premiums are not received by the due date, subject to the grace period provision, and if payment is received within 63 days from the last date of coverage, the Member will be reinstated. Reinstatement is restricted to one time in a 12 month period. Members terminated due to non-payment will be required to wait 6 months to re-enroll in the Plan
Part VI. Benefits and Coverages
All services listed in the Member Fee Schedules will be provided if, in the opinion of the Participating Provider, they are necessary. The fee charged will be the fee listed in the Member Fee Schedule for each service.
Part VII. Change in Service
Plan reserves the right to change the premiums or Member Fee Schedules on a uniform basis for all Members. No change will be made without first posting the changes at www.ntidirectcare.net for 60 days.
Part VIII. How to Receive Benefits
Members must contact Participating Providers to schedule service. Members must pay fees at the time of service. Fees are paid directly to Participating Providers who render service.
Part IX. Complaints and Grievances
Complaints for services provided should be brought to the attention of the Participating Provider.
Complaints for the ntiDirectCare program should be directed to:
2250 Erin Court
Lancaster, Pennsylvania 17601