{"component": "clause", "props": {"groups": [{"size": 6, "samples": [{"hash": "hmohJIndBeW", "uri": "/contracts/hmohJIndBeW#managed-care-program-requirements", "label": "Epo Agreement of Coverage", "score": 25.81724846, "published": true}, {"hash": "1AdwVEisHQP", "uri": "/contracts/1AdwVEisHQP#managed-care-program-requirements", "label": "Epo Agreement of Coverage", "score": 25.5872689938, "published": true}], "snippet_links": [{"key": "managed-care-program", "type": "clause", "offset": [6, 26]}, {"key": "the-insured", "type": "clause", "offset": [36, 47]}, {"key": "plan-providers", "type": "definition", "offset": [49, 63]}, {"key": "agreed-to", "type": "clause", "offset": [114, 123]}, {"key": "participate-in", "type": "definition", "offset": [124, 138]}, {"key": "payment-in-full", "type": "definition", "offset": [243, 258]}, {"key": "payment-of", "type": "definition", "offset": [300, 310]}, {"key": "calendar-year-deductible", "type": "definition", "offset": [326, 350]}, {"key": "coinsurance-amount", "type": "definition", "offset": [365, 383]}, {"key": "exclusive-provider-organization", "type": "definition", "offset": [452, 483]}, {"key": "the-services", "type": "definition", "offset": [504, 516]}, {"key": "benefit-payments", "type": "definition", "offset": [555, 571]}, {"key": "emergency-services", "type": "definition", "offset": [650, 668]}, {"key": "urgently-needed-services", "type": "definition", "offset": [672, 696]}, {"key": "services-provided-by", "type": "clause", "offset": [716, 736]}, {"key": "a-non", "type": "clause", "offset": [737, 742]}, {"key": "authorized-by", "type": "definition", "offset": [772, 785]}, {"key": "outpatient-facility", "type": "definition", "offset": [891, 910]}, {"key": "complex-diagnostic", "type": "clause", "offset": [972, 990]}, {"key": "therapeutic-services", "type": "definition", "offset": [994, 1014]}, {"key": "in-no-event-will", "type": "clause", "offset": [1016, 1032]}, {"key": "maximum-payment", "type": "clause", "offset": [1055, 1070]}, {"key": "shl-reimbursement-schedule", "type": "definition", "offset": [1100, 1126]}, {"key": "to-verify", "type": "definition", "offset": [1163, 1172]}, {"key": "the-provider", "type": "clause", "offset": [1178, 1190]}, {"key": "any-non", "type": "clause", "offset": [1236, 1243]}, {"key": "services-and", "type": "clause", "offset": [1254, 1266]}, {"key": "rules-of", "type": "definition", "offset": [1292, 1300]}, {"key": "failure-of-the", "type": "clause", "offset": [1329, 1343]}, {"key": "the-requirements", "type": "clause", "offset": [1367, 1383]}, {"key": "reduction-of-benefits", "type": "clause", "offset": [1431, 1452]}, {"key": "benefits-payable", "type": "clause", "offset": [1454, 1470]}, {"key": "prior-authorization", "type": "definition", "offset": [1641, 1660]}], "snippet": "SHL's Managed Care Program requires the Insured, Plan Providers and SHL to work together. All Plan Providers have agreed to participate in SHL\u2019s Managed Care Program. Plan Providers have agreed to accept SHL\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Insured\u2019s payment of any applicable Calendar Year Deductible, Copayment or Coinsurance amount, whereas Non-Plan Providers have not. Insureds enrolled under SHL\u2019s Exclusive Provider Organization (EPO) Plans who use the services of Non-Plan Providers will receive no benefit payments or reimbursement for amounts for any Covered Service, except \uf0b7 in the case of Emergency Services or Urgently Needed Services or \uf0b7 other Covered Services provided by a Non-Plan Provider that are Prior Authorized by SHL\u2019s Managed Care Program. This includes any Prior Authorized Covered Services obtained from a Non-Plan outpatient facility, such as a laboratory, radiological facility (x-ray), or any complex diagnostic or therapeutic services. In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule. It is the Insured's responsibility to verify that the Provider selected is a Plan Provider before receiving any non-Emergency Services and to comply with all other rules of SHL\u2019s Managed Care Program. Failure of the Insured to comply with the requirements of SHL\u2019s Managed Care Program will result in a reduction of benefits. Benefits payable for Covered Services from Plan Providers which are not Prior Authorized by SHL\u2019s Managed Care Program will be reduced to 50% of what the Insured would have received with Prior Authorization.", "hash": "930bf3992a730aefa6bba1aa2a1b127e", "id": 1}, {"size": 5, "samples": [{"hash": "figIMFmlpho", "uri": "/contracts/figIMFmlpho#managed-care-program-requirements", "label": "Group Health Insurance Certificate of Coverage", "score": 27.417522245, "published": true}, {"hash": "bbSX0gUX60u", "uri": "/contracts/bbSX0gUX60u#managed-care-program-requirements", "label": "Group Health Insurance Certificate of Coverage", "score": 25.8829568789, "published": true}], "snippet_links": [{"key": "managed-care-program", "type": "clause", "offset": [6, 26]}, {"key": "the-insured", "type": "clause", "offset": [36, 47]}, {"key": "plan-providers", "type": "definition", "offset": [49, 63]}, {"key": "agreed-to", "type": "clause", "offset": [114, 123]}, {"key": "participate-in", "type": "definition", "offset": [124, 138]}, {"key": "payment-in-full", "type": "definition", "offset": [243, 258]}, {"key": "payment-of", "type": "definition", "offset": [300, 310]}, {"key": "calendar-year-deductible", "type": "definition", "offset": [326, 350]}, {"key": "coinsurance-amount", "type": "definition", "offset": [365, 383]}, {"key": "in-no-event-will", "type": "clause", "offset": [422, 438]}, {"key": "maximum-payment", "type": "clause", "offset": [461, 476]}, {"key": "shl-reimbursement-schedule", "type": "definition", "offset": [506, 532]}, {"key": "to-verify", "type": "definition", "offset": [569, 578]}, {"key": "the-provider", "type": "clause", "offset": [584, 596]}, {"key": "any-non", "type": "clause", "offset": [642, 649]}, {"key": "services-and", "type": "clause", "offset": [660, 672]}, {"key": "comply-with", "type": "clause", "offset": [676, 687]}, {"key": "rules-of", "type": "definition", "offset": [698, 706]}, {"key": "benefits-payable", "type": "clause", "offset": [735, 751]}, {"key": "expenses-incurred", "type": "clause", "offset": [756, 773]}, {"key": "in-connection-with", "type": "clause", "offset": [774, 792]}, {"key": "covered-services-which-are", "type": "clause", "offset": [793, 819]}, {"key": "authorized-by", "type": "definition", "offset": [830, 843]}, {"key": "the-services", "type": "definition", "offset": [937, 949]}], "snippet": "SHL's Managed Care Program requires the Insured, Plan Providers and SHL to work together. All Plan Providers have agreed to participate in SHL\u2019s Managed Care Program. Plan Providers have agreed to accept SHL\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Insured\u2019s payment of any applicable Calendar Year Deductible, Copayment or Coinsurance amount, whereas Non-Plan Providers have not. In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule. It is the Insured's responsibility to verify that the Provider selected is a Plan Provider before receiving any non-Emergency Services and to comply with all other rules of SHL\u2019s Managed Care Program. Benefits payable for expenses incurred in connection with Covered Services which are not Prior Authorized by SHL\u2019s Managed Care Program will be reduced to 50% of what the Insured would have received if the services had been Prior Authorized.", "hash": "50ecb3628f0bef262f98919d9541e416", "id": 2}, {"size": 2, "samples": [{"hash": "aAHZnN98OfW", "uri": "/contracts/aAHZnN98OfW#managed-care-program-requirements", "label": "Epo Agreement of Coverage", "score": 26.8357289528, "published": true}, {"hash": "1mNExlaltsZ", "uri": "/contracts/1mNExlaltsZ#managed-care-program-requirements", "label": "Epo Agreement of Coverage", "score": 26.5167693361, "published": true}], "snippet_links": [{"key": "managed-care-program", "type": "clause", "offset": [6, 26]}, {"key": "the-insured", "type": "clause", "offset": [36, 47]}, {"key": "plan-providers", "type": "definition", "offset": [49, 63]}, {"key": "agreed-to", "type": "clause", "offset": [114, 123]}, {"key": "participate-in", "type": "definition", "offset": [124, 138]}, {"key": "payment-in-full", "type": "definition", "offset": [243, 258]}, {"key": "payment-of", "type": "definition", "offset": [300, 310]}, {"key": "calendar-year-deductible", "type": "definition", "offset": [326, 350]}, {"key": "coinsurance-amount", "type": "definition", "offset": [365, 383]}, {"key": "exclusive-provider-organization", "type": "definition", "offset": [452, 483]}, {"key": "the-services", "type": "definition", "offset": [504, 516]}, {"key": "benefit-payments", "type": "definition", "offset": [555, 571]}, {"key": "emergency-services", "type": "definition", "offset": [650, 668]}, {"key": "urgently-needed-services", "type": "definition", "offset": [672, 696]}, {"key": "services-provided-by", "type": "clause", "offset": [716, 736]}, {"key": "a-non", "type": "clause", "offset": [737, 742]}, {"key": "authorized-by", "type": "definition", "offset": [772, 785]}, {"key": "outpatient-facility", "type": "definition", "offset": [891, 910]}, {"key": "complex-diagnostic", "type": "clause", "offset": [972, 990]}, {"key": "therapeutic-services", "type": "definition", "offset": [994, 1014]}, {"key": "in-no-event-will", "type": "clause", "offset": [1016, 1032]}, {"key": "maximum-payment", "type": "clause", "offset": [1055, 1070]}, {"key": "shl-reimbursement-schedule", "type": "definition", "offset": [1100, 1126]}], "snippet": "SHL's Managed Care Program requires the Insured, Plan Providers and SHL to work together. All Plan Providers have agreed to participate in SHL\u2019s Managed Care Program. Plan Providers have agreed to accept SHL\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Insured\u2019s payment of any applicable Calendar Year Deductible, Copayment or Coinsurance amount, whereas Non-Plan Providers have not. Insureds enrolled under SHL\u2019s Exclusive Provider Organization (EPO) Plans who use the services of Non-Plan Providers will receive no benefit payments or reimbursement for amounts for any Covered Service, except \uf0b7 in the case of Emergency Services or Urgently Needed Services or \uf0b7 other Covered Services provided by a Non-Plan Provider that are Prior Authorized by SHL\u2019s Managed Care Program. This includes any Prior Authorized Covered Services obtained from a Non-Plan outpatient facility, such as a laboratory, radiological facility (x-ray), or any complex diagnostic or therapeutic services. In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule.", "hash": "90e7e16aa934b6b38682e4fbaf2722f2", "id": 3}, {"size": 2, "samples": [{"hash": "3DxPmi0wTBi", "uri": "/contracts/3DxPmi0wTBi#managed-care-program-requirements", "label": "Group Enrollment Agreement", "score": 31.8563998229, "published": true}, {"hash": "2nipX0p8ghd", "uri": "/contracts/2nipX0p8ghd#managed-care-program-requirements", "label": "Agreement of Coverage", "score": 26.8357289528, "published": true}], "snippet_links": [{"key": "managed-care-program", "type": "clause", "offset": [6, 26]}, {"key": "the-member", "type": "clause", "offset": [36, 46]}, {"key": "plan-providers", "type": "definition", "offset": [48, 62]}, {"key": "agreed-to", "type": "clause", "offset": [113, 122]}, {"key": "participate-in", "type": "definition", "offset": [123, 137]}, {"key": "reimbursement-schedule", "type": "definition", "offset": [209, 231]}, {"key": "payment-in-full", "type": "definition", "offset": [242, 257]}, {"key": "covered-services", "type": "definition", "offset": [262, 278]}, {"key": "payment-of", "type": "definition", "offset": [298, 308]}, {"key": "calendar-year-deductible", "type": "definition", "offset": [324, 348]}, {"key": "coinsurance-amount", "type": "definition", "offset": [363, 381]}], "snippet": "HPN's Managed Care Program requires the Member, Plan Providers and HPN to work together. All Plan Providers have agreed to participate in HPN\u2019s Managed Care Program. Plan Providers have agreed to accept HPN\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Member\u2019s payment of any applicable Calendar Year Deductible, Copayment or Coinsurance amount, whereas Non-Plan Providers have not.", "hash": "b4bba5e5ec01946024d38078aa59c05a", "id": 4}, {"size": 2, "samples": [{"hash": "izOvsdMb5n5", "uri": "/contracts/izOvsdMb5n5#managed-care-program-requirements", "label": "Agreement of Coverage", "score": 22.453798768, "published": true}, {"hash": "ajXzZHLGw1k", "uri": "/contracts/ajXzZHLGw1k#managed-care-program-requirements", "label": "Agreement of Coverage", "score": 22.453798768, "published": true}], "snippet_links": [{"key": "complete-the", "type": "clause", "offset": [27, 39]}, {"key": "prior-authorization-form", "type": "definition", "offset": [40, 64]}, {"key": "copy-to", "type": "definition", "offset": [76, 83]}, {"key": "the-provider", "type": "clause", "offset": [84, 96]}, {"key": "the-member", "type": "clause", "offset": [101, 111]}, {"key": "services-and-supplies", "type": "definition", "offset": [144, 165]}, {"key": "guarantee-of-payment", "type": "clause", "offset": [196, 216]}, {"key": "final-decision", "type": "definition", "offset": [222, 236]}, {"key": "a-member", "type": "clause", "offset": [346, 354]}, {"key": "grievance-review-committee", "type": "definition", "offset": [471, 497]}, {"key": "section-10", "type": "definition", "offset": [503, 513]}, {"key": "appeals-procedures", "type": "clause", "offset": [515, 533]}], "snippet": "Following review, HPN will complete the Prior Authorization form and send a copy to the Provider and the Member. The form will specify approved services and supplies. Prior Authorization is not a guarantee of payment. The final decision as to whether any care should be received is between the Member and the Provider. If HPN denies a request by a Member and/or Provider for Prior Authorization of a service or supply, the Member or Provider may appeal the denial to the Grievance Review Committee (see Section 10, Appeals Procedures).", "hash": "9549417d981914f78eca209c0f774a69", "id": 5}, {"size": 2, "samples": [{"hash": "inZ10Vh9WH2", "uri": "/contracts/inZ10Vh9WH2#managed-care-program-requirements", "label": "Agreement of Coverage", "score": 25.81724846, "published": true}], "snippet_links": [{"key": "managed-care-program", "type": "clause", "offset": [6, 26]}, {"key": "the-member", "type": "clause", "offset": [36, 46]}, {"key": "plan-providers", "type": "definition", "offset": [48, 62]}, {"key": "agreed-to", "type": "clause", "offset": [113, 122]}, {"key": "participate-in", "type": "definition", "offset": [123, 137]}, {"key": "payment-in-full", "type": "definition", "offset": [242, 257]}, {"key": "payment-of", "type": "definition", "offset": [298, 308]}, {"key": "calendar-year-deductible", "type": "definition", "offset": [324, 348]}, {"key": "coinsurance-amount", "type": "definition", "offset": [363, 381]}, {"key": "hmo-plans", "type": "definition", "offset": [449, 458]}, {"key": "the-services", "type": "definition", "offset": [467, 479]}, {"key": "benefit-payments", "type": "definition", "offset": [518, 534]}, {"key": "emergency-services", "type": "definition", "offset": [613, 631]}, {"key": "urgently-needed-services", "type": "definition", "offset": [635, 659]}, {"key": "other-covered-services", "type": "clause", "offset": [670, 692]}, {"key": "a-non", "type": "clause", "offset": [730, 735]}, {"key": "authorized-by", "type": "definition", "offset": [765, 778]}, {"key": "outpatient-facility", "type": "definition", "offset": [884, 903]}, {"key": "complex-diagnostic", "type": "clause", "offset": [965, 983]}, {"key": "therapeutic-services", "type": "definition", "offset": [987, 1007]}, {"key": "in-no-event-will", "type": "clause", "offset": [1009, 1025]}, {"key": "maximum-payment", "type": "clause", "offset": [1048, 1063]}, {"key": "hpn-reimbursement-schedule", "type": "definition", "offset": [1093, 1119]}, {"key": "to-verify", "type": "definition", "offset": [1155, 1164]}, {"key": "the-provider", "type": "clause", "offset": [1170, 1182]}, {"key": "any-non", "type": "clause", "offset": [1228, 1235]}, {"key": "services-and", "type": "clause", "offset": [1246, 1258]}, {"key": "comply-with", "type": "clause", "offset": [1262, 1273]}, {"key": "rules-of", "type": "definition", "offset": [1284, 1292]}], "snippet": "HPN's Managed Care Program requires the Member, Plan Providers and HPN to work together. All Plan Providers have agreed to participate in HPN\u2019s Managed Care Program. Plan Providers have agreed to accept HPN\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Member\u2019s payment of any applicable Calendar Year Deductible, Copayment or Coinsurance amount, whereas Non-Plan Providers have not. Members enrolled under HPN\u2019s HMO Plans who use the services of Non-Plan Providers will receive no benefit payments or reimbursement for amounts for any Covered Service, except \uf0b7 in the case of Emergency Services or Urgently Needed Services; or \uf0b7 for other Covered Services, as defined in this AOC, provided by a Non-Plan Provider that are Prior Authorized by HPN\u2019s Managed Care Program. This includes any Prior Authorized Covered Services obtained from a Non-Plan outpatient facility, such as a laboratory, radiological facility (x-ray), or any complex diagnostic or therapeutic services. In no event will HPN pay more than the maximum payment allowance established in the HPN Reimbursement Schedule. It is the Member's responsibility to verify that the Provider selected is a Plan Provider before receiving any non-Emergency Services and to comply with all other rules of HPN\u2019s Managed Care Program.", "hash": "97910b4528cf4eb9df8bedd41f6c50ab", "id": 6}, {"size": 1, "samples": [{"hash": "22UdqpdimTx", "uri": "/contracts/22UdqpdimTx#managed-care-program-requirements", "label": "Agreement of Coverage", "score": 25.6343633132, "published": true}], "snippet_links": [{"key": "managed-care-program", "type": "clause", "offset": [6, 26]}, {"key": "the-insured", "type": "clause", "offset": [36, 47]}, {"key": "plan-providers", "type": "definition", "offset": [49, 63]}, {"key": "agreed-to", "type": "clause", "offset": [116, 125]}, {"key": "participate-in", "type": "definition", "offset": [126, 140]}, {"key": "payment-in-full", "type": "definition", "offset": [245, 260]}, {"key": "covered-services", "type": "definition", "offset": [265, 281]}, {"key": "payment-of", "type": "definition", "offset": [302, 312]}, {"key": "applicable-copayment", "type": "clause", "offset": [317, 337]}, {"key": "coinsurance-amount", "type": "definition", "offset": [353, 371]}, {"key": "in-no-event-will", "type": "clause", "offset": [410, 426]}, {"key": "maximum-payment", "type": "clause", "offset": [449, 464]}, {"key": "shl-reimbursement-schedule", "type": "definition", "offset": [494, 520]}, {"key": "form-no", "type": "clause", "offset": [522, 529]}, {"key": "to-verify", "type": "definition", "offset": [593, 602]}, {"key": "services-requiring-prior-authorization", "type": "clause", "offset": [657, 695]}, {"key": "comply-with", "type": "clause", "offset": [703, 714]}, {"key": "rules-of", "type": "definition", "offset": [725, 733]}], "snippet": "SHL's Managed Care Program requires the Insured, Plan Providers and SHL to work together. \u2022 All Plan Providers have agreed to participate in SHL\u2019s Managed Care Program. Plan Providers have agreed to accept SHL\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Insured\u2019s payment of any applicable Copayment, Deductible or Coinsurance amount, whereas Non-Plan Providers have not. In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule. Form No. SHL-Ind_AOC(2015) Page 6 \u2022 It is the Insured's responsibility to verify Prior Authorization has been obtained for any Covered Services requiring Prior Authorization and to comply with all other rules of SHL\u2019s Managed Care Program.", "hash": "c821e4f89a1d4e0fc731390f6c2059a6", "id": 7}, {"size": 1, "samples": [{"hash": "guRNs2PL0aj", "uri": "/contracts/guRNs2PL0aj#managed-care-program-requirements", "label": "Individual Agreement of Coverage", "score": 25.6371006808, "published": true}], "snippet_links": [{"key": "prior-authorization", "type": "definition", "offset": [0, 19]}, {"key": "the-member", "type": "clause", "offset": [44, 54]}, {"key": "grievance-review-committee", "type": "definition", "offset": [96, 122]}, {"key": "section-11", "type": "definition", "offset": [128, 138]}, {"key": "appeals-procedures", "type": "clause", "offset": [140, 158]}], "snippet": "Prior Authorization of a service or supply, the Member or Provider may appeal the denial to the Grievance Review Committee (see Section 11, Appeals Procedures).", "hash": "53d65d79a5767f9c777783eaadf00cb2", "id": 8}, {"size": 1, "samples": [{"hash": "5hqVUONY2Vo", "uri": "/contracts/5hqVUONY2Vo#managed-care-program-requirements", "label": "Agreement of Coverage", "score": 24.75566832, "published": true}], "snippet_links": [{"key": "final-decision", "type": "definition", "offset": [4, 18]}, {"key": "the-member", "type": "clause", "offset": [72, 82]}, {"key": "the-provider", "type": "clause", "offset": [87, 99]}, {"key": "a-member", "type": "clause", "offset": [128, 136]}, {"key": "prior-authorization", "type": "definition", "offset": [157, 176]}, {"key": "grievance-review-committee", "type": "definition", "offset": [253, 279]}, {"key": "section-10", "type": "definition", "offset": [285, 295]}, {"key": "appeals-procedures", "type": "clause", "offset": [297, 315]}], "snippet": "The final decision as to whether any care should be received is between the Member and the Provider. If HPN denies a request by a Member and/or Provider for Prior Authorization of a service or supply, the Member or Provider may appeal the denial to the Grievance Review Committee (see Section 10, Appeals Procedures).", "hash": "e763e4a3130c265a7178c2af7dc10a84", "id": 9}, {"size": 1, "samples": [{"hash": "iHztpua0lff", "uri": "/contracts/iHztpua0lff#managed-care-program-requirements", "label": "Ppo Agreement of Coverage", "score": 22.453798768, "published": true}], "snippet_links": [{"key": "to-provide", "type": "definition", "offset": [29, 39]}, {"key": "benefits-payable", "type": "clause", "offset": [79, 95]}, {"key": "expenses-incurred", "type": "clause", "offset": [100, 117]}, {"key": "in-connection-with", "type": "clause", "offset": [118, 136]}, {"key": "covered-services", "type": "definition", "offset": [137, 153]}, {"key": "authorized-by", "type": "definition", "offset": [175, 188]}, {"key": "managed-care-program", "type": "clause", "offset": [193, 213]}, {"key": "as-shown", "type": "definition", "offset": [231, 239]}, {"key": "attachment-a", "type": "definition", "offset": [247, 259]}, {"key": "benefit-schedule", "type": "clause", "offset": [260, 276]}, {"key": "the-insured", "type": "clause", "offset": [314, 325]}, {"key": "plan-providers", "type": "definition", "offset": [327, 341]}, {"key": "agreed-to", "type": "clause", "offset": [394, 403]}, {"key": "participate-in", "type": "definition", "offset": [404, 418]}, {"key": "payment-in-full", "type": "definition", "offset": [523, 538]}, {"key": "payment-of", "type": "definition", "offset": [580, 590]}, {"key": "applicable-copayment", "type": "clause", "offset": [595, 615]}, {"key": "coinsurance-amount", "type": "definition", "offset": [631, 649]}, {"key": "in-no-event-will", "type": "clause", "offset": [689, 705]}, {"key": "maximum-payment", "type": "clause", "offset": [728, 743]}, {"key": "shl-reimbursement-schedule", "type": "definition", "offset": [773, 799]}], "snippet": "the most appropriate setting to provide healthcare in a cost-effective manner. Benefits payable for expenses incurred in connection with Covered Services, which are not Prior Authorized by the Managed Care Program, will be reduced as shown in the Attachment A Benefit Schedule. SHL's Managed Care Program requires the Insured, Plan Providers and SHL to work together. \uf0b7 All Plan Providers have agreed to participate in SHL\u2019s Managed Care Program. Plan Providers have agreed to accept SHL\u2019s Reimbursement Schedule amount as payment in full for Covered Services, less the Insured\u2019s payment of any applicable Copayment, Deductible or Coinsurance amount, whereas Non- Plan Providers have not. In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule.", "hash": "c54503a6d50e0f3bec194f244a2965e1", "id": 10}], "next_curs": "CmoSZGoVc35sYXdpbnNpZGVyY29udHJhY3RzckYLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IiptYW5hZ2VkLWNhcmUtcHJvZ3JhbS1yZXF1aXJlbWVudHMjMDAwMDAwMGEMogECZW4YACAA", "clause": {"parents": [["managed-care-program", "Managed Care Program"], ["managed-care", "Managed Care"], ["termination", "Termination"], ["effect-of-termination", "Effect of Termination"]], "title": "Managed Care Program Requirements", "size": 24, "children": [], "id": "managed-care-program-requirements", "related": [["program-requirements", "Program Requirements", "Program Requirements"], ["child-abuse-reporting-requirements", "Child Abuse Reporting Requirements", "Child Abuse Reporting Requirements"], ["system-requirements", "System Requirements", "System Requirements"], ["child-abuse-reporting-requirement", "Child Abuse Reporting Requirement", "Child Abuse Reporting Requirement"], ["federal-medicaid-system-security-requirements-compliance", "Federal Medicaid System Security Requirements Compliance", "Federal Medicaid System Security Requirements Compliance"]], "related_snippets": [], "updated": "2025-07-07T16:38:45+00:00"}, "json": true, "cursor": ""}}