Accessing Care Sample Clauses

Accessing Care. 1. Members are entitled to Covered Services from the following: Your Provider Network is KFHPWA’s Core Network (Network). Members are entitled to Covered Services only at Network Facilities and from Network Providers, except for Emergency services and care pursuant to a Preauthorization.
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Accessing Care. 1. Members are entitled to Covered Services from the following: Members are entitled to Covered Services only at Core Network Facilities and from Core Network Providers, except for Emergency services and care pursuant to a Preauthorization.
Accessing Care. Members are entitled to Covered Services only at GHC Facilities and from GHC Personal Physicians. Except as follows: • Emergency care, • Self-Referral to women’s health care providers, as set forth below, • Visits with GHC-Designated Self-Referral Specialists, as set forth below, • Care provided pursuant to a Referral. Referrals must be requested by the Member’s Personal Physician and approved by GHC, and • Other services as specifically set forth in the Allowances Schedule and Section IV.
Accessing Care. 1. Members are entitled to Covered Services from the following: • Your Provider Network is KFHPWAO’s Access PPO Preferred Provider Network, referred to as “PPN”. o Standard in-network benefits apply to any Preferred Provider o Enhanced in-network benefits apply when a Members utilizes designated integrated providers (Xxxxxx Permanente Medical Centers and providers or other designated providers as identified in the Provider Directory). These providers provide services at the lowest cost share as stated in Section IV. • Care provided by an Out-of-Network Provider, except prescription drugs. Coverage provided by an Out-of-Network Provider is limited to the Allowed Amount. o Out-of-Country providers are limited to a provider who meets licensing and certification requirements established where the provider practices. Benefits paid under one option will not be duplicated under the other option.
Accessing Care. 1. Members are entitled to Covered Services from the following: Your Provider Network is KFHPWA’s Connect Network (Network). Members are entitled to Covered Services only at Network Facilities and from Network Providers, except for Emergency services and care pursuant to a Preauthorization. • Telehealth Services (Telemedicine, Telephone Services and Online (e-visits)) benefits apply at the lowest cost share as stated in Section IV. These services include; secure messaging, telephone visits, video visits, Care Chat, Consulting Nurse Service, online e-visits. Please see Telehealth Services in Section IV for additional information. • In-person authorized benefits apply when the Member has utilized a Telehealth Service and is approved for an in-person visit with a Network Provider. • In-person self-directed benefits apply when the Member has received in-person care without first obtaining approval through Telehealth Services.
Accessing Care. Members are entitled to Covered Services from either: • GHO’s Managed Health Care Network, referred to as “MHCN,” or • Community Providers or Preferred Community Providers on a Self-Referred basis. Members may choose either health care delivery option at any time during or for differing episodes of illness or injury, except during a scheduled inpatient admission. Benefits paid under one option will not be duplicated under the other option. Under the Agreement, the level of benefits available for services received at or upon Referral by the MHCN is generally greater than the level of benefits available for services received from Community Providers. In order for services to be covered at the higher benefit level, services must be obtained by MHCN Providers at MHCN Facilities, except as follows: • Emergency care, • Self-Referral to women’s MHCN health care providers, as set forth below, • Visits with MHCN-Designated Self-Referral Specialists, as set forth below, • Care provided pursuant to a Referral. Referrals must be requested by the Member’s MHCN Personal Physician and approved by GHO, and • Other services as specifically set forth in the Allowances Schedule and Section IV. Some services are covered only when obtained from or upon Referral by the MHCN. All inpatient admissions prescribed by a Community Provider must be authorized in advance by GHO. Members may refer to Sections IV.A. and IV.C. for more information about inpatient admissions.
Accessing Care. Members are entitled to Covered Services only at GHC Facilities and from GHC Personal Physicians. Except as follows: • Emergency care, • Self-Referral to women’s health care providers, as set forth below, • Visits with GHC-Designated Self-Referral Specialists, as set forth below, • Care provided pursuant to a Referral. Referrals must be requested by the Member’s Personal Physician and approved by GHC, and • Other services as specifically set forth in the Allowances Schedule and Section IV. Members may refer to Sections IV.A. and IV.C. for more information about inpatient admissions.
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Accessing Care. Members are entitled to Covered Services only at GHC Facilities and from GHC Personal Physicians, except for Emergency care and care pursuant to an Authorization. Members may refer to Sections IV.A. and IV.C. for more information about inpatient admissions.
Accessing Care. 1. Members are entitled to Covered Services from the following: Your Provider Network is KFHPWA’s Core Network (Network). Members are entitled to Covered Services only at Network Facilities and from Network Providers, except for Emergency services and care pursuant to a Preauthorization. Benefits under this EOC will not be denied for any health care service performed by a registered nurse licensed to practice under chapter 18.88 RCW, if first, the service performed was within the lawful scope of such nurse’s license, and second, this EOC would have provided benefit if such service had been performed by a Doctor of Medicine licensed to practice under chapter 18.71 RCW. A listing of Core Network Personal Physicians, specialists, women’s health care providers and KFHPWA- designated Specialists is available by contacting Member Services or accessing the KFHPWA website at xxx.xx.xxx/xx. Information available online includes each physician’s location, education, credentials, and specialties. KFHPWA also utilizes Health Care Benefit Managers for certain services. To see a list of Health Care Benefit Managers, go to xxxxx://xxxxxxx.xxxxxxxxxxxxxxxx.xxx/washington/support/forms and click on the “Evidence of coverage” link. KFHPWA will not directly or indirectly prohibit Members from freely contracting at any time to obtain health care services from Non-Network Providers and Non-Network Facilities outside the Plan. However, if you choose to receive services from Non-Network Providers and Non-Network Facilities except as otherwise specifically provided in this EOC, those services will not be covered under this EOC and you will be responsible for the full price of the services. Any amounts you pay for non-covered services will not count toward your Out-of-Pocket Limit.
Accessing Care. 1. Members are entitled to Covered Services from the following:  Care provided by Group Health’s Access PPO Preferred Provider Network, referred to as “PPN”. o Standard in-network benefits apply to any Preferred Provider o Enhanced in-network benefits apply when a Members utilizes designated integrated providers (Group Health Medical Centers and providers or other designated providers as identified in the Provider Directory)  Care provided by an Out-of-Network Provider. Coverage provided by an Out-of-Network Provider is limited to the Allowed Amount. o Out-of-Country providers are limited to Emergency services and urgent care only when provided by a provider who meets licensing and certification requirements established where the provider practices. Benefits paid under one option will not be duplicated under the other option. In order for services to be covered at the highest benefit levels, services must be obtained from PPN Facilities or Preferred Providers, except for Emergency services. Emergency services will always be covered at the in-network (PPN) level. A listing of Access PPO Preferred Providers is available by contacting Customer Service or accessing the Group Health website at xxx.xxx.xxx.
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