Provider Exclusions Sample Clauses

Provider Exclusions. The Division will not reimburse the Contractor for services rendered by any provider that is excluded from participation by Medicare, Medicaid, including any other states’ Medicaid program, or SCHIP, including any other states’ or SCHIP program, except for emergency services.
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Provider Exclusions. The Division will not reimburse the Contractor for services rendered by any provider that is excluded from participation by Medicare, Medicaid, including any other states’ Medicaid program, or SCHIP, including any other states’ or SCHIP program, except for emergency services. The Contractor must ensure that all their providers and subcontractor entities screen their employees for excluded persons. The Contractor must communicate this obligation to all providers and subcontractors upon credentialing and re-credentaling and upon renewal of any subcontracts. The Division will require the Contractor to search the HHS-OIG website by names of any individual or entity for exclusions and require this to be done monthly to capture exclusions and reinstatements. In addition, the Contractor may search List of Excluded Individuals and Entities (LEIE), Medicare Exclusion Databank (MED), National Practitioner Data Bank (NPDB), Health Integrity and Protection Databank (HIPDB), General Services Administration (GSA) Excluded Parties List Service (EPLS); State Board of Examiners. The Contractor must search the exclusions database monthly. These searches must include any providers, entities and individuals with ownership or control interests in any entity. The Division may impose civil monetary penalties against the Contractor if they employ or enter into a contract with excluded individuals or entities to provide items or services to Medicaid beneficiaries.
Sample 1
Provider Exclusions. As to Provider’s liability, the Provider Cap for direct damages liability and the Section 16.3 limitation on non-direct damages shall not apply to: (a) Losses arising under or relating to Provider’s failure to comply with Article 8; (b) Losses resulting from Provider’s failure to comply with any Force of Law Requirements; (c) Losses arising under or relating to the gross negligence, willful misconduct or fraud of Provider; (d) any introduction by Provider or Provider Personnel of Malicious Code in the Commission’s environment, network or systems, to the extent Losses caused by such introduction arise from acts, errors or omissions of Provider or Provider Personnel that constitute gross negligence or willful misconduct; (e) personal injury, including death, and damage to tangible personal or real property caused by the grossly negligent, willful or intentional acts of a Provider or Provider Personnel; (f) amounts owed by Provider due to a Net Income Shortfall under Section 5.3.4; or (g) Provider’s wrongful termination of this Agreement or repudiation or wrongful abandonment of all or any part of the Services.
Sample 1

Related to Provider Exclusions

  • Service Exclusions All of an Employee's years of Service with the Employer shall be counted to determine the vested interest of such Employee except:

  • Program Exclusions The borrower cannot be in active bankruptcy. The borrower’s first-lien mortgage cannot be a home equity line of credit, third party contract, or other private party loan. The borrower cannot own other residential real property. Employees of contractor Further.

  • GENERAL EXCLUSIONS We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regard- less of any other cause or event contributing concur- rently or in any sequence to the loss.

  • for exclusions The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider.

  • Additional Exclusions The Insurer shall not be liable for:

  • Specific Exclusions Apart from the exclusions common to all covers, the following are also excluded. We do not intervene for:  Travel taken for the purpose of diagnosis and/or treatment,  Medical and hospitalisation expenses in the country of residence,  Drunkenness, suicide or attempted suicide and their consequences,  Any voluntary mutilation of the insured,  Ailments or benign injuries which can be treated on site and/or which do not prevent the Beneficiary/Insured from continuing his trip,  The states of pregnancy, unless there are unforeseeable complications, and in all cases, the states of pregnancy beyond the 36th week, voluntary termination, the aftermath of childbirth,  Convalescence and ailments during treatment, not yet consolidated and involving a risk of sudden aggravation,  Illnesses diagnosed previously that have resulted in hospitalisation in the 6 months preceding the date of departure on the trip,  Events related to medical treatment or surgery that are not unforeseen, fortuitous or accidental,  Prosthesis costs: optical, dental, acoustic, functional, etc.  The consequences of infectious risk situations in an epidemic context that are subject to quarantine or preventive measures or specific surveillance by the international health authorities and/or local health authorities of the country where you are staying and/or national authorities of your country of origin, unless otherwise specified in the cover.  The costs of spa treatment, cosmetic treatment, vaccination and resultant costs,  Stays in a rest home and the resultant costs,  Rehabilitation, physiotherapy, chiropractic and resultant costs,  Scheduled hospitalisations. In the event of significant trauma following your quarantine related to a context of epidemic or pandemic, we can, at your request, put you in contact with a psychologist by telephone, within the limit indicated in the Schedule of Cover. These sessions are strictly confidential. This listening work is not to be confused with the psychotherapeutic work done by licensed practitioners. Under no circumstances can this service be a substitute for psychotherapy, due to the physical absence of the caller. EMERGENCY SUITCASE In the event that you no longer have enough usable personal effects at your disposal due to your quarantine or your hospitalisation following an epidemic or pandemic, we pay, on presentation of supporting documents, for basic necessities, up to the amount indicated in the Schedule of Cover. DOMESTIC HELP Following your repatriation by us following an illness linked to an epidemic or a pandemic, if you cannot perform your usual household chores, we look for, arrange and pay for domestic help assistance, within the limit indicated in the Schedule of Cover. DELIVERY OF HOUSEHOLD SHOPPING Following your repatriation by us following an illness linked to an epidemic or a pandemic, if you are not able to leave your home, we organize and cover, within the limit of local availability, the costs of delivery of your shopping within the limit set in the Schedule of Cover. PSYCHOLOGICAL SUPPORT UPON YOUR RETURN HOME In the event of significant trauma following an event related to a context of epidemic or pandemic, we can, at your request, put you in contact with a psychologist by telephone after you return home, within the limit indicated in the Schedule of Cover. These sessions are strictly confidential. This listening work is not to be confused with the psychotherapeutic work done by licensed practitioners. Under no circumstances can this service be a substitute for psychotherapy, due to the physical absence of the caller. NEED ASSISTANCE? Contact us, 7 days/week and 24 hours/day By ‘phone from France: By e-mail +00 0 00 00 00 00 (Call not surcharged, cost according to operator, call may be recorded) xxxxxxxxxx@xxxxxxxx.xx To allow us to intervene under the best conditions, remember to prepare the following information that will be requested when you call: › Your policy number, › Your last and first names, › Your home address, › The country, city or town where you are at the time of the call, › Specify the exact address (no., street, hotel possibly, etc.), › The phone number where we can reach you, › The nature of your problem. When you call initially, you will be given an assistance file number. State it systematically during any subsequent contacts with our Assistance Service.  General Provisions - the policy came with the purchase of goods or a service sold by a supplier; - you can show that you are already covered for one of the risks covered by this new policy; - the policy you wish to cancel has not been fully established; - you have not declared any loss covered by this policy. In this situation, you can exercise your right to cancel this policy by letter or in any lasting medium sent to the insurer of the new policy, together with documentary proof that you already have cover for one of the risks covered by this new policy. The insurer must reimburse you the premium paid within thirty days of your cancellation. If you wish to cancel your policy but do not meet all the above conditions, please check the cancellation procedure stipulated in your policy. Like any insurance policy, this one comprises mutual rights and obligations. It is governed by the French Insurance Code. These rights and obligations are set forth in the following pages. This is a collective damage insurance policy taken out by Gritchen Affinity with MUTUAIDE ASSISTANCE with optional membership.

  • Religious Exclusions Deductions for membership dues and assessments shall not apply to any employee who, for religious reasons, cannot pay union dues and assessments, provided she makes a contribution equal to said union dues and assessments to some recognized charitable cause.

  • Warranty Exclusions The Limited Warranty in clauses 1.2 and 1.3 does not apply:

  • Exclusions The Warrant Agent shall have no responsibility with respect to the validity of this Agreement or with respect to the validity or execution of any Warrant (except its countersignature thereof). The Warrant Agent shall not be responsible for any breach by the Company of any covenant or condition contained in this Agreement or in any Warrant. The Warrant Agent shall not be responsible to make any adjustments required under the provisions of Section 4 hereof or responsible for the manner, method, or amount of any such adjustment or the ascertaining of the existence of facts that would require any such adjustment; nor shall it by any act hereunder be deemed to make any representation or warranty as to the authorization or reservation of any shares of Common Stock to be issued pursuant to this Agreement or any Warrant or as to whether any shares of Common Stock shall, when issued, be valid and fully paid and non-assessable.

  • General Exclusion Neither we nor our directors, officers, employees, or agents shall be liable for any losses, damages, costs or expenses, whether arising out of negligence, breach of contract, misrepresentation or otherwise, incurred or suffered by you under this Agreement (including any Transaction or where we have declined to enter into a proposed Transaction) unless such loss is a reasonably foreseeable consequence or arises directly from our or their respective gross negligence, wilful default or fraud. In no circumstance, shall we have liability for losses suffered by you or any third party for any special or consequential damage, loss of profits, loss of goodwill or loss of business opportunity arising under or in connection with this Agreement, whether arising out of negligence, breach of contract, misrepresentation or otherwise. Nothing in this Agreement will limit our liability for death or personal injury resulting from our negligence.

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