Common use of Specialists and Other Providers Clause in Contracts

Specialists and Other Providers. 1. In addition to the above requirements, the Health Plan shall assure the availability of the following specialists, as appropriate for both adults and pediatric Enrollees, on at least a referral basis. The Health Plan shall use Participating Specialists with pediatric expertise for Children/Adolescents when the need for pediatric specialty care is significantly different from the need for adult specialty care (for example a pediatric cardiologist for Children/Adolescents with congenital heart defects).

Specialists and Other Providers. 1. In addition to the above requirements, the Health Plan shall assure the availability of the following specialists, as appropriate for both adults and pediatric Enrolleesmembers, on at least a referral basis. The Health Plan shall use Participating Specialists with pediatric expertise for Children/Adolescents when the need for pediatric specialty care is significantly different from the need for adult specialty care (for example a pediatric cardiologist for Children/Adolescents with congenital heart defects).