Physician and Provider Options Sample Clauses

Physician and Provider Options a. Within the Empower Plan Service Area, Members are entitled to receive Covered Benefits and Services from AvMed Empower In-Network (Participating) Tier A or Tier B Providers, or from Out- of-Network (Non-Participating) Providers, as described in this Contract.
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Physician and Provider Options a. Within the Agility Plan Service Area, Members are entitled to receive Covered Benefits and Services from AvMed Agility In-Network (Participating) Providers, or from Out-of-Network (Non- Participating) Providers, as described in this Contract.
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Physician and Provider Options a. Within the Service Area, Members are entitled to receive Covered Benefits and Covered Services from Participating Providers, or from Non-Participating Providers, as described in this Contract. Within the Service Area, Covered Benefits and Covered Services from Participating Providers will be paid at the high Benefit Level. Covered Benefits and Covered Services from Non-Participating Providers will be paid at the low Benefit Level.
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Physician and Provider Options a. Within the Choice Plan Service Area, Members are entitled to receive Covered Benefits and Services from AvMed Choice Plan Participating (In-Network) Providers, or from Non-Participating (Out-of- Network) Providers, as described in this Contract.
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Physician and Provider Options a. Within the Plan Service Area, Members are entitled to receive Covered Benefits and Services from In-Network Providers, or from Out-of-Network Providers, as described in this Contract.
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Physician and Provider Options a. Within the Elite Plan Service Area, Members are entitled to receive Covered Benefits and Services from AvMed Elite In-Network (Participating) Providers, or from Out-of-Network (Non- Participating) Providers, as described in this Contract.
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Physician and Provider Options a. Within the Flex Plan Service Area, Members are entitled to receive Covered Benefits and Services from AvMed Flex In-Network (Participating) Providers, or from Out-of-Network (Non- Participating) Providers, as described in this Contract.
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Related to Physician and Provider Options

  • Excluded Providers 6.4.1 Definition of Excluded Providers In accordance with 42 CFR 438.214(d), the Contractor may not employ or contract with Providers who are Excluded from participation in Federal Health Care Programs under either Section 1128 or 1128(A) of the Social Security Act.

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • PROVIDER PERSONNEL 9.1 The Department and Provider agree and acknowledge that in the event of the Provider ceasing to provide the Services or part of them for any reason, Clause 25 (Re-Provision of the Services) of the Agreement will apply.

  • Participating Providers To find out if a Provider is a Participating Provider: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at xxx.xxxxxx.xxx. The Provider directory will give You the following information about Our Participating Providers: • Name, address, and telephone number; • Specialty; • Board certification (if applicable); • Languages spoken; and • Whether the Participating Provider is accepting new patients.

  • CLAIM FILING AND PROVIDER PAYMENTS This section provides information regarding how a member may file a claim for a covered healthcare service and how we pay providers for a covered healthcare service. How to File a Claim Network providers file claims on your behalf. Non-network providers may or may not file claims on your behalf. If a non-network provider does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the provider’s itemized bill, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the provider who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered healthcare service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated. How Network Providers Are Paid We pay network providers directly for covered healthcare services. Network providers agree not to bill, charge, collect a deposit from, or seek reimbursement from you for a covered healthcare service, except for your share under the plan. When you see a network provider, you are responsible for a share of the cost of covered healthcare services. Your share includes the deductible, if one applies, and the copayment, as listed in the Summary of Medical Benefits. The covered healthcare service may also have a benefit limit, which caps the amount we will reimburse the provider for that service. You will be responsible for any amount over the benefit limit, up to the allowance. Your provider may request these payments at the time of service, or may bill you after the service. If you do not pay your provider, the provider may decline to provide current or future services or may pursue payment from you, such as beginning collection proceedings. Some of our agreements with network providers include alternative payment methods such as incentives, risk-sharing, care coordination, value-based, capitation or similar payment methods. Your copayments are determined based on our allowance at the date the service is rendered. Your copayment may be more or less than the amount the network provider receives under these alternative payment methods. Your copayment will not be adjusted based on these alternative payment methods, or for any payment that is not calculated on an individual claim basis. Our contracts with providers may establish a payment allowance for multiple covered healthcare services, and we may apply a single copayment based on these arrangements. In these cases, you will typically be responsible for fewer copayments than if your share of the cost had been determined on a per service basis.

  • Service Provider The Service Provider also represents at the date this Agreement is entered into and any Service is used or provided:

  • Replacement of Key Personnel The Engineer must notify the State in writing as soon as possible, but no later than three business days after a project manager or other key personnel is removed from association with this contract, giving the reason for removal.

  • Contractor’s Services a. Contractor shall perform all Services in accordance with Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054 and all applicable state and federal laws.

  • Contractor Key Personnel ‌ The Contractor shall assign a Corporate OASIS Program Manager (COPM) and Corporate OASIS Contract Manager (COCM) as Contractor Key Personnel to represent the Contractor as primary points-of-contact to resolve issues, perform administrative duties, and other functions that may arise relating to OASIS and task orders solicited and awarded under XXXXX. Additional Key Personnel requirements may be designated by the OCO at the task order level. There is no minimum qualification requirements established for Contractor Key Personnel. Additionally, Contractor Key Personnel do not have to be full-time positions; however, the Contractor Key Personnel are expected to be fully proficient in the performance of their duties. The Contractor shall ensure that the OASIS CO has current point-of-contact information for both the COPM and COCM. In the event of a change to Contractor Key Personnel, the Contractor shall notify the OASIS CO and provide all Point of Contact information for the new Key Personnel within 5 calendar days of the change. All costs associated with Contractor Key Personnel duties shall be handled in accordance with the Contractor’s standard accounting practices; however, no costs for Contractor Key Personnel may be billed to the OASIS Program Office. Failure of Contractor Key Personnel to effectively and efficiently perform their duties will be construed as conduct detrimental to contract performance and may result in activation of Dormant Status and/or Off-Ramping (See Sections H.16. and H.17.).

  • Contractor’s Key Personnel The Contractor shall use adequate numbers of qualified individuals with suitable training, education, experience and skill to perform the Services. The Contractor has been selected to perform the Services herein, in part, because of the skills and expertise of the key individuals and/or firms (collectively “Contractor’s Key Personnel”) that are listed in Exhibit F. Substitution or replacement of the individuals and/or firms identified in Exhibit F is not allowed except with written approval of the AOC If the designated lead or key person fails to perform to the satisfaction of the AOC upon written notice, the Contractor will have fifteen (15) calendar days to remove that person from the Project and replace that person with one acceptable to the AOC. All lead or key personnel for any Subcontractor must also be designated by any Subcontractor and are subject to all conditions stated in this section. The Contractor shall be responsible for all costs associated with replacing any of Contractor’s Key Personnel, including the additional costs to familiarize replacement personnel with the Services. If the Contractor does not furnish replacement personnel acceptable to the AOC, the AOC may terminate this Agreement for cause. Prior to the authorization of any Phase of the Agreement, the parties will agree upon any Key Personnel applicable to that Phase. Said personnel shall be documented in Exhibit F. Standard of Care The Contractor, its officers, agents, employees, Subcontractors, consultants and any persons or entities for whom Contractor is responsible, shall provide all Services pursuant to this Agreement in accordance with the requirements of this Agreement and in a manner consistent with the standard of care under California law applicable to those who specialize in providing such services for projects of the type, scope, and complexity of the Project. The AOC’s Acceptance of any submittals, deliverables, or other work product of the Contractor shall not be construed as assent that Contractor has complied, nor in any way relieve the Contractor of, compliance with (i) the applicable standard of care or (ii) applicable statutes, regulations, rules, guidelines, and requirements. AOC’s Quality Assurance Plan The AOC or its agent may evaluate Contractor’s performance under this Agreement. Such evaluation may include assessing Contractor’s compliance with all Agreement terms and performance standards. Any deficiencies in the Contractor’s performance that the AOC determines are severe or continuing and that may place performance of the Agreement in jeopardy if not corrected, will be reported to the Contractor’s principal. The report may include recommended improvements and corrective measures to be taken by the Contractor. If the Contractor’s performance remains unsatisfactory, the AOC may, without limitation, terminate this Agreement for cause or impose other penalties as specified in this Agreement. Any evaluation of Contractor’s performance conducted by the AOC shall not be construed as an Acceptance of the Contractor’s work product or methods of performance. Contractor shall be solely responsible for the quality, completeness, and accuracy of the work product that Contractor and its Subcontractors deliver under this Agreement. Contractor shall not rely on AOC to perform any quality control review of Contractor’s work product, as such review shall be conducted by Contractor.

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