Responsibility for Members at Termination Sample Clauses
The 'Responsibility for Members at Termination' clause defines how obligations toward members are handled when an agreement or membership ends. Typically, this clause clarifies which party is responsible for outstanding duties, such as final payments, benefits, or notifications to members, upon termination. For example, it may specify whether the organization or the departing member must fulfill certain requirements before the relationship is fully concluded. Its core function is to ensure a clear allocation of responsibilities at the end of the agreement, thereby preventing disputes and ensuring a smooth transition for all parties involved.
Responsibility for Members at Termination. In the event that this Agreement is terminated (other than for loss of licensure or failure to comply with legal requirements as provided in Section V hereof), PROVIDER shall continue to provide Covered Services to a Member who is receiving Covered Services from PROVIDER on the effective termination date of this Agreement for a minimum transitional period of sixty (60) days from the date the Member is notified of the termination or pending termination, or until the Covered Services being rendered to the Member by PROVIDER are completed (consistent with existing medical ethical and/or legal requirements for providing continuity of care to a Member), unless ▇▇▇▇▇ or a Plan makes reasonable and Medically Appropriate provision for the assumption of such Covered Services by another Participating Provider. ▇▇▇▇▇ shall compensate PROVIDER for those Covered Services provided to a Member pursuant to this paragraph (prior to and following the effective termination date of this Agreement) at the rates contemplated for Covered Services in this Agreement.
(a) In consultation with Plan(s), the Member and/or the PROVIDER may extend the transitional period if it is determined to be clinically appropriate, or in order to comply with the requirements of applicable Plan documents and/or accrediting standards. PROVIDER shall continue to provide Covered Services to such Member(s) and the Parties agree that all such Covered Services rendered shall be subject to the terms and conditions contained in this Agreement (including reimbursement rates) that are effective as of the date of termination.
(b) Should ▇▇▇▇▇ and/or Plan(s) initiate termination of this Agreement, PROVIDER acknowledges and agrees PROVIDER’s obligations as set forth in this Section VII survive such termination.
Responsibility for Members at Termination. Pursuant to Title 11 NCAC 20.0202(5), in the event that this Agreement is terminated (other than for loss of licensure or failure to comply with legal requirements as provided in Section V hereof), or in the event that ▇▇▇▇▇ and/or Plan(s) become insolvent, PROVIDER shall cooperate with ▇▇▇▇▇ in the transition of administrative duties and records and shall continue to provide Covered Services to a Member who is receiving Covered Services from PROVIDER on the effective termination date of this Agreement for a minimum transitional period of sixty (60) days from the date the Member is notified of the termination or pending termination, or until the Covered Services being rendered to the Member by PROVIDER are completed (consistent with existing medical ethical and/or legal requirements for providing continuity of care to a Member), unless ▇▇▇▇▇ or a Plan makes reasonable and Medically Appropriate provision for the assumption of such Covered Services by another Participating Provider. ▇▇▇▇▇ shall compensate PROVIDER for those Covered Services provided to a Member pursuant to this paragraph (prior to and following the effective termination date of this Agreement) at the rates contemplated for Covered Services in this Agreement.
(a) Pursuant to 11 NCAC 20.0202(5), in the case of insolvency with health maintenance organization or of ▇▇▇▇▇, PROVIDER’s continuing obligations after termination of this Agreement shall, after the health maintenance organization or ▇▇▇▇▇’ insolvency, include the transition of administrative duties and records and the continuation of the provision of Covered Services to Enrollee(s) for the duration of the period for which premium payment has been made and, if applicable, until the Enrollee’s discharge from inpatient facilities.
(b) In consultation with Plan(s), the Member and/or the PROVIDER may extend the transitional period if it is determined to be clinically appropriate, or in order to comply with the requirements of applicable Plan documents and/or accrediting standards. PROVIDER shall continue to provide Covered Services to such Member(s) and the parties agree all such Covered Services rendered shall be subject to the terms and conditions contained in this Agreement (including reimbursement rates) that are effective as of the date of termination.
(c) Should ▇▇▇▇▇ and/or Plan(s) initiate termination of this Agreement, or should ▇▇▇▇▇ and/or Plan(s) become insolvent, PROVIDER acknowledges and agrees PROVIDER’s obligations as set for...
Responsibility for Members at Termination. In the event that this Agreement is terminated (other than for loss of licensure or failure to comply with legal requirements as provided in Section V hereof), PROVIDER shall continue to provide Covered Services to a Member who is receiving Covered Services from PROVIDER on the effective termination date of this Agreement until the Covered Services being rendered to the Member by PROVIDER are completed (consistent with existing medical ethical and/or legal requirements for providing continuity of care to a patient), unless ▇▇▇▇▇ or a Plan makes reasonable and Medically Appropriate provision for the assumption of such Covered Services by another Participating Provider. ▇▇▇▇▇ shall compensate PROVIDER for those Covered Services provided to a Member pursuant to this paragraph (prior to and following the effective termination date of this Agreement) at the rates contemplated in this Agreement for Covered Services.
Responsibility for Members at Termination. In the event that this Agreement is terminated (other than for loss of licensure or failure to comply with legal requirements as provided in Section V hereof), PROVIDER shall continue to provide Covered Services to a Member who is receiving Covered Services from PROVIDER on the effective termination date of this Agreement for a minimum transitional period of ninety (90) days, or until the Covered Services being rendered to the Member by PROVIDER are completed (consistent with existing medical ethical and/or legal requirements for providing continuity of care to a Member), unless ▇▇▇▇▇ or a Plan makes reasonable and Medically Appropriate provision for the assumption of such Covered Services by another Participating Provider. ▇▇▇▇▇ shall compensate PROVIDER for those Medically Appropriate, Covered Services provided to a Member pursuant to this Section VII.4 (prior to and following the effective termination date of this Agreement) at the rates for Covered Services indicated in Exhibit 1 of this Agreement. Any dispute arising from this paragraph shall be resolved in accordance with the then current ▇▇▇▇▇ Vision Care Plan Provider Manual.
(a) In consultation with Plan(s), the Member and/or the PROVIDER may extend the transitional period if it is determined to be clinically appropriate, or in order to comply with the requirements of applicable Plan documents, with accrediting standards, or with TX HMO Act §843.362 regarding Member(s) who have a “special circumstance” and in accordance with the dictates of medical prudence. For the purposes of this Section VII.4, “special circumstance” means a condition regarding which a PROVIDER reasonably believes that discontinuing care would cause harm to a Member/patient. Examples of a Member who has a “special circumstance” include, but are not limited to, a Member with a disability, acute condition, life-threatening illness, or who is past the twenty-fourth (24th) week of pregnancy. PROVIDER shall continue to provide Covered Services to such Member(s) and the Parties agree all such Covered Services rendered shall be subject to the terms and conditions contained in this Agreement (including reimbursement rates) that are effective as of the date of termination.
(b) Should ▇▇▇▇▇ and/or Plan(s) initiate termination of this Agreement, PROVIDER acknowledges and agrees PROVIDER’s obligations as set forth in this Section VII survive such termination.
Responsibility for Members at Termination. Specialists affiliated with Provider Group shall continue to provide Covered Services to a Member who is receiving Covered Services from Provider Group on the effective termination date of this Agreement until the Covered Services being rendered to the Member by Specialist's are completed (consistent with existing medical ethical/legal requirements for providing continuity of care to a patient), unless MHG or a Plan makes reasonable and medically appropriate provision for the assumption of such Covered Services by another physician or other appropriate healthcare professional. MHG shall compensate Provider Group for those Covered Services provided to a Member pursuant to this Section 8.6 (prior to and following the effective termination date of this Agreement) in accordance with a fee-for-service basis established by MHG from time to time using the Medicare allowable fee schedule.
Responsibility for Members at Termination. In the event of termination of this Agreement other than as provided in subsection 9.4(1) above, BJC and BJC Providers shall continue to provide Covered Services to Members in accordance with this Agreement for one year from the effective date of termination. Any such Covered Services rendered by BJC or BJC Providers to Members on a post-termination basis pursuant to this Section shall be reimbursed by the Plan or the appropriate Payor at the rate at which BJC and BJC providers are compensated during the period immediately preceding such termination.
Responsibility for Members at Termination. In the event the Agreement is terminated for any reason except the failure to comply with legal requirements or the loss of licensure (as set forth in Section V of the Agreement), where medically necessary for the Member to continue treatment with PROVIDER, PROVIDER shall be continue to provide Covered Services as provided in Section VII.4 of the Agreement for up to one hundred twenty (120) days after such termination of the Agreement.