Plan Service Area Sample Clauses

Plan Service Area. The geographic area served by this Plan is de- fined as the Plan Service Area. Subscribers and Dependents must live or work within the pre- scribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. For spe- cific information on the boundaries of the Plan if applicable, the provider or another health bene- fit plan, in accordance with applicable laws and regulations. Blue Shield reserves the right to deduct or offset any amounts paid in error from any pending or future claim to the extent permit- xxx by law. Circumstances that might result in payment of a claim in error include, but are not limited to, payment of benefits in excess of the benefits provided by the health plan, payment of amounts that are the responsibility of the Sub- xxxxxxx or Member (deductibles, copayments, coinsurance or similar charges), payment of amounts that are the responsibility of another payor, payments made after termination of the Subscriber or Member’s eligibility, or payments on fraudulent claims. Service Area members may call Customer Ser- vice at the number provided on the back page of this EOC. Liability of Subscribers in the Event of Non-Payment by Blue Shield In accordance with Blue Shield’s established poli- cies, and by statute, every contract between Blue Shield and its Plan Providers stipulates that the Sub- xxxxxxx shall not be responsible to the Plan Provider for compensation for any services to the extent that they are provided in the Member’s group contract. Plan Providers have agreed to accept the Blue Shield’s payment as payment-in-full for Covered Services, except for Deductibles, Copayments, Coinsurance, amounts in excess of specified Benefit maximums, or as provided under the Exception for Other Coverage provision and the Reductions sec- tion regarding Third Party Liability. If services are provided by a non-Plan provider, the Member is responsible for all amounts Blue Shield does not pay. When a Benefit specifies a Benefit maximum and that Benefit maximum has been reached, the Mem- ber is responsible for any charges above the Benefit maximums.
Sample 1
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Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or reside within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. Please see the Plan Service Area chart at the back of this booklet for additional information on the geographic area served by this Plan. For specific information on the boundaries of the Plan Service Area members may also call Customer Service at the telephone number listed on the back page of this Evidence of Coverage Liability of Subscribers in the Event of Non-Payment by Blue Shield
Sample 1Sample 2
Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or reside within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. Please see the Plan Service Area chart at the back of this booklet for additional information on the geographic area served by this Plan. For specific information on the boundaries of the Plan Service Area members may also call Customer Service at the telephone number listed on the back page of this Evidence of Coverage.
Sample 1
Plan Service Area the geographic area consisting of the following counties in western Pennsylvania: Allegheny Centre (Part) Forest Xxxxxx Xxxxxxxxx Clarion Xxxxxx Xxxxxx Xxxxxx Clearfield Huntingdon Somerset Bedford Xxxxxxxx Indiana Venango Xxxxx Elk Xxxxxxxxx Xxxxxx Xxxxxx Erie Xxxxxxxx Xxxxxxxxxx Cambria Xxxxxxx XxXxxx Xxxxxxxxxxxx Xxxxxxx 113. PRECERTIFICATION (CERTIFICATION) - a process whereby the Medical Necessity and Appropriateness of Inpatient admissions, Services or place of Services is determined by the Plan prior to, or after, an admission or the performance of a procedure or Service.
Sample 1
Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or work within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. For specific information on the boundaries of the Plan Service Area members may call Shield Concierge at the number provided on the back page of this EOC. (Special arrangements may be available for Dependents who are full-time students or do not live in the Subscriber’s home. Please contact the Member Services Department to request an Away Liability of Subscribers in the Event of Non-Payment by Blue Shield In accordance with Blue Shield’s established poli- cies, and by statute, every contract between Blue Shield and its Plan Providers stipulates that the Sub- xxxxxxx shall not be responsible to the Plan Provider for compensation for any services to the extent that they are provided in the Member’s group contract. Plan Providers have agreed to accept the Blue Shield’s payment as payment-in-full for Covered Services, except for Deductibles, Copayments and Coinsurance, and amounts in excess of specified Benefit maximums, or as provided under the Excep- tion for Other Coverage provision and the Reduc- tions section regarding Third Party Liability. If services are provided by a non-Plan provider, the Member is responsible for all amounts Blue Shield does not pay. When a Benefit specifies a Benefit maximum and that Benefit maximum has been reached, the Mem- ber is responsible for any charges above the Benefit maximums.
Sample 1
Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or work within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. For specific information on the boundaries of the Plan Service Area members may call Customer Service at the number provided on the back page of this EOC. (Special arrangements may be available for Dependents who are full-time students or do not live in the Subscriber’s home. Please contact the Member Services Department to request an Away From Home Care Program Brochure which explains these arrangements). Liability of Subscribers in the Event of Non-Payment by Blue Shield In accordance with Blue Shield’s established poli- cies, and by statute, every contract between Blue Shield and its Plan Providers stipulates that the Sub- xxxxxxx shall not be responsible to the Plan Provider for compensation for any services to the extent that they are provided in the Member’s group contract. Plan Providers have agreed to accept the Blue Shield’s payment as payment-in-full for Covered Services, except for Deductibles, Copayments and Coinsurance, and amounts in excess of specified Benefit maximums, or as provided under the Excep- tion for Other Coverage provision and the Reduc- tions section regarding Third Party Liability. If services are provided by a non-Plan provider, the Member is responsible for all amounts Blue Shield does not pay. When a Benefit specifies a Benefit maximum and that Benefit maximum has been reached, the Mem- ber is responsible for any charges above the Benefit maximums.
Sample 1
Plan Service Area. For retirees who are eligible for Employer-paid Retiree Health Plan and who move to another Xxxxxx Permanente Region, the retiree will be required to participate in the out-of- region plan. The retiree, spouse or domestic partner, will be required to assign Medicare, when applicable. For retirees who are eligible for Employer-paid Retiree Health Plan and who move to an area not served by Xxxxxx Permanente, an out-of-area plan is available. The retiree also has the option of maintaining their Southern California Xxxxxx Permanente Retiree Health Plan. 2118 Retirees who reestablish residence within the service area will be returned to Kaiser Health Plan Coverage, within sixty (60) days of written notification of return to the Southern California Health Plan service area. Premiums for the alternative health plan will not exceed the premiums for Kaiser Health Plan Coverage.
Sample 1
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Related to Plan Service Area

  • Service Area (a) SORACOM shall provide the SORACOM Air Global Service within the area designated on the web site of SORACOM (the “Service Area”), provided, that, the Service Area may be different if stated otherwise as specified by SORACOM separately. However, within the Service Area, you may not use the SORACOM Air Global Service in places where transmissions are difficult to send or receive.

  • Service Areas The MCP agrees to provide services to Aged, Blind or Disabled (ABD) members, Modified Adjusted Gross Income (MAGI) members, and Adult Extension members residing in the following service area(s): Central/Southeast Region ☒ Northeast Region ☒ West Region ☒ The ABD and MAGI categories of assistance are described in OAC rule 5160-26-02. The Adult Extension category is defined in Ohio’s Medicaid State Plan as authorized by the Centers for Medicare and Medicaid Services (CMS). The MCP shall serve all counties in any region they agree to serve.

  • Interconnection Customer Compensation If the CAISO requests or directs the Interconnection Customer to provide a service pursuant to Articles 9.6.3 (Payment for Reactive Power) or 13.5.1 of this LGIA, the CAISO shall compensate the Interconnection Customer in accordance with the CAISO Tariff.

  • Covered Services Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.

  • Infertility Services This plan covers the following services, in accordance with R.I. General Law §27-20-20. • Services for the diagnosis and treatment of infertility if you are:

  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment.

  • Shared Services 5.1.1 ETFO agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis.

  • Maternity Services Your benefits for maternity services are the same as your benefits for any other condition and are available whether you have Individual Coverage or Family Coverage. Benefits will be provided for delivery charges and for any of the pre­ viously described Covered Services when rendered in connection with pregnancy. Benefits will be provided for any treatment of an illness, injury, congenital defect, birth abnormality or a premature birth from the moment of the birth up to the first 31 days, thereafter, you must add the newborn child to your Family Coverage. Premiums will be adjusted accordingly. Coverage will be provided for the mother and the newborn for a minimum of:

  • COMMERCIAL REUSE OF SERVICES The member or user herein agrees not to replicate, duplicate, copy, trade, sell, resell nor exploit for any commercial reason any part, use of, or access to 's sites.

  • Staffing Plan 8.l The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

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