Participating Infertility Specialist. A Specialist who has entered into a contractual agreement with HMO for the provision of Infertility services to Members. • Physician(s). A duly licensed member of a medical profession, who has an M.D. or D.O. degree, who is properly licensed or certified to provide medical care under the laws of the state where the individual practices, and who provides Medical Services which are within the scope of the individual’s license or certificate. • Premium(s). The amount the Contract Holder or Member is required to pay to HMO to continue coverage. • Primary Care Physician (PCP). A Participating Physician who supervises, coordinates and provides initial care and basic Medical Services as a general or family care practitioner, or in some cases, as an internist or a pediatrician to Members, initiates their Referral for Specialist care, and maintains continuity of patient care. • Provider(s). A Physician, Health Professional, Hospital, Skilled Nursing Facility, home health agency or other recognized entity or person licensed to provide Hospital or Medical Services to Members.
Participating Infertility Specialist. A Specialist who has entered into a contractual agreement with HMO for the provision of Infertility services to Members. • Physician. A duly licensed member of a medical profession, who has an M.D. or D.O. degree, who is properly licensed or certified to provide medical care under the laws of the state where the individual practices, and who provides Medical Services which are within the scope of the individual’s license or certificate. This definition includes podiatrists, osteopaths, chiropractors, nurse midwives, midwives and nurse anesthetists. • Premium(s). The amount the Contract Holder or Member is required to pay to HMO to continue coverage. • Primary Care Physician (PCP). A Participating Physician who supervises, coordinates and provides initial care and basic Medical Services as a general or family care practitioner, or in some cases, as an internist or a pediatrician to Members, initiates their Referral for Specialist care, and maintains continuity of patient care. • Provider(s). A Physician, Health Professional, Hospital, Skilled Nursing Facility, home health agency or other recognized entity or person licensed to provide Hospital or Medical Services to Members.
Participating Infertility Specialist. A Specialist who has entered into a contractual agreement with HMO for the provision of Infertility services to Members. • Physician. A duly licensed member of a medical profession, who has an M.D. or D.O. degree, who is properly licensed or certified to provide medical care under the laws of the state where the individual practices, and who provides Medical Services which are within the scope of the individual’s license or certificate. • Premium. The amount the Contract Holder or Member is required to pay to HMO to continue coverage. • Primary Care Physician. A Participating Physician, who supervises, coordinates and provides initial care and basic Medical Services as a general or family care practitioner, or in some cases, as an internist or a pediatrician to Members, initiates their Referral for Specialist care, and maintains continuity of patient care. • Provider. A Physician, Health Professional, Hospital, Skilled Nursing Facility, home health agency or other recognized entity or person licensed to provide Hospital or Medical Services to Members. • Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Self-injectable Drug(s). Prescription drugs that are intended to be self administered by injection to a specific part of the body to treat certain chronic medical conditions. An updated copy of the list of Self- injectable Drugs that are not Covered Benefits shall be available upon request by the Member or may be accessed at the HMO website, at xxx.xxxxx.xxx. The list is subject to change by HMO or an affiliate. • Service Area. The geographic area, established by HMO and approved by the appropriate reg...
Participating Infertility Specialist. A Specialist who has entered into a contractual agreement with HMO for the provision of Infertility services to Members. • Physician. A duly licensed member of a medical profession, who has an M.D. or D.O. degree, who is properly licensed or certified to provide medical care under the laws of the state where the individual practices, and who provides Medical Services which are within the scope of the individual’s license or certificate. • Premium. The amount the Contract Holder or Member is required to pay to HMO to continue coverage. • Primary Care Physician. A Participating Physician who supervises, coordinates and provides initial care and basic Medical Services as a general or family care practitioner, or in some cases, as an internist or a pediatrician to Members, initiates their Referral for Specialist care, and maintains continuity of patient care. • Provider. A Physician, Health Professional, Hospital, Skilled Nursing Facility, home health agency or other recognized entity or person licensed to provide Hospital or Medical Services to Members.
Participating Infertility Specialist. A Specialist who has entered into a contractual agreement with HMO for the provision of Infertility services to Members. • Pervasive Developmental Disorders. Include Autistic Disorder, Rett’s disorder, Childhood Disintegrative Disorder, Asperger’s Disorder and Pervasive Developmental Disorder Not Otherwise Specified (including Atypical Autism), in accordance with the Diagnostic and Statistical Manual for Mental Disorders –IV- Text Revision (June 2000). • Physician. A duly licensed member of a medical profession, who has an M.D. or D.O. degree, who is properly licensed or certified to provide medical care under the laws of the state where the individual practices, and who provides Medical Services which are within the scope of the individual’s license or certificate. • Premium. The amount the Contract Holder or Member is required to pay to HMO to continue coverage. • Primary Care Physician. A Participating Physician who supervises, coordinates and provides initial care and basic Medical Services as a general or family care practitioner, or in some cases, as an internist, obstetrician, gynecologist or a pediatrician to Members, initiates their Referral for Specialist care, and maintains continuity of patient care. • Provider(s). A Physician, Health Professional, Hospital, Skilled Nursing Facility, home health agency or other recognized entity or person licensed to provide Hospital or Medical Services to Members.
Participating Infertility Specialist. A Specialist who has entered into a contractual agreement with HMO for the provision of Infertility services to Members. • Physician(s). A duly licensed member of a medical profession, who has an M.D. or D.O. degree, who is properly licensed or certified to provide medical care under the laws of the state where the individual practices, and who provides Medical Services which are within the scope of the individual’s license or certificate. • Premium(s). The amount the Contract Holder or Member is required to pay to HMO to continue coverage. • Primary Care Physician (PCP). A Participating Physician who supervises, coordinates and provides initial care and basic Medical Services as a general or family care practitioner, or in some cases, as an internist or a pediatrician to Members, initiates their Referral for Specialist care, and maintains continuity of patient care. • Prior Plan. The plan of group health care benefits sponsored by the Contract Holder within 90 days prior to the effective date of this Group Agreement and which has been replaced by coverage under this HMO. • Provider(s). A Physician, Health Professional, Hospital, Skilled Nursing Facility, home health agency or other recognized entity or person licensed to provide Hospital or Medical Services to Members.
