Plan Hospitals Clause Samples
The "Plan Hospitals" clause defines the requirements and standards for hospitals that are included in a specific health insurance plan or network. It typically outlines which hospitals are considered in-network, the criteria they must meet to participate, and any obligations regarding quality of care or reporting. For example, it may specify that only accredited hospitals within a certain geographic area are covered, or that hospitals must provide certain services to plan members. The core function of this clause is to ensure that insured individuals have access to a defined set of hospitals that meet agreed-upon standards, thereby providing clarity and consistency in the delivery of healthcare services under the plan.
Plan Hospitals. Each PMG is affiliated with at least one Plan Hospital. Consequently, except for Emergency Services, each Member must receive Hospital Services from the Plan Hospital affiliated with the PMG selected by or for the Member. In the event Hospital Services are not available at such Plan Hospital, the Member will be referred to another Plan Hospital to receive such Hospital Services. If services for the medically necessary treatment of a mental health or substance use disorder are not available in network within the geographic and timely access standards set by law or regulation, the health care service plan shall arrange coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary follow-up services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this subdivision, to “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary out-of-network options that are available to the enrollee within geographic and timely access standards. The enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from an in-network provider.
Plan Hospitals. Each Plan Medical Group is affiliated with at least one Plan Hospital. Consequently, except for Emergency Services, each Member must receive Hospital Services from the Plan Hospital affiliated with the Plan Medical Group selected by or for the Member. In the event Hospital Services are not available at such Plan Hospital, the Member will be referred to another Plan Hospital to receive such Hospital Services.
Plan Hospitals. Each PMG is affiliated with at least one Plan Hospital. Consequently, except for Emergency Services, each Member must receive Hospital Services from the Plan Hospital affiliated with the PMG selected by or for the Member. In the event Hospital Services are not available at such Plan Hospital, the Member will be referred to another Plan Hospital to receive such Hospital Services.