CALIFORNIACARE definition

CALIFORNIACARE means direct care prepayment plan(s) offered by BLUE CROSS.

Examples of CALIFORNIACARE in a sentence

  • PARTICIPATING MEDICAL GROUP should notify the CALIFORNIACARE Case Manager prior to the Member achieving the applicable Case Management Stop-Loss Threshold, as described below.

  • To comply with all CALIFORNIACARE administrative policies and procedures in the areas listed in Exhibit C (incorporated by reference herein) and as set forth in the Operations Manual (incorporated by reference herein) and to comply with all applicable state and federal laws and regulations relating to the delivery of Covered Medical Services.

  • The Case Management Program is a program in which a Member’s medical needs are assessed by PARTICIPATING MEDICAL GROUP in conjunction with a CALIFORNIACARE Case Manager to explore and coordinate treatment alternatives.

  • Notwithstanding the aforementioned, any claims for Non-Capitated Services or Shared Risk Services (as defined in the CALIFORNIACARE Medical Services Agreement in effect for years prior to 1997) paid after April 30, 1997 will be charged to the 1997 Non-Capitated Expense.

  • HEALTH PLANS Full-time employees of the University have a choice of the PRUDENT BUYER PLAN (PPO) or CALIFORNIACARE PLAN (HMO) sponsored by BLUECROSS OF CALIFORNIA.

  • The single source separated items are, but not limited to: cardboard, newspaper print, office paper, glass, aluminum containers, plastics, tires, and non-ferrous scrap metals.

  • BLUE CROSS and PARTICIPATING MEDICAL GROUP have previously entered into a CALIFORNIACARE Medical Services Agreement (“Agreement”), effective January 1, 2000 whereby PARTICIPATING MEDICAL GROUP is designated as a PARTICIPATING MEDICAL GROUP.

  • Section 5.01 shall be deleted and Section 5.01 is hereby restated in full to read: To perform or arrange for the performance of all necessary accounting and enrollment functions with respect to marketing and administering the CALIFORNIACARE program and AIM Program and to issue a CALIFORNIACARE or an AIM identification card to each Subscriber or each Subscriber and one additional eligible Member covered under a two-party or family contract as described in the Operations Manual.

  • In the case of non-contracting providers, BLUE CROSS shall pay the lesser of: the actual billed charges, or the maximum allowable rate according to the BLUE CROSS Customary and Reasonable charges, or the rate arranged for by a CALIFORNIACARE Case Manager.

  • FOR IMMEDIATE RELEASE December 19, 1996 Media Contact: Cynthia Coulter (818) 703-3046 Investor Contact: John Cygul (818) 703-4321 CALIFORNIACARE HEALTH PLANS RECEIVES NCQA ONE-YEAR ACCREDITATION WOODLAND HILLS, Calif.

Related to CALIFORNIACARE

  • California company means a sole proprietorship, partnership, joint venture, corporation, or other business entity that was a licensed California contractor on the date when bids for the public contract were opened and meets one of the following:

  • AT&T CALIFORNIA means the AT&T owned ILEC doing business in California.

  • AT&T SOUTH CAROLINA means the AT&T owned ILEC doing business in South Carolina.

  • Health practitioner means a registered health practitioner registered or licensed as a health practitioner under an appropriate law of the State of Tasmania.

  • State health plan means the employee and retiree insurance program provided for in Article 5, Chapter 11, Title 1.

  • Psychiatric hospital means an Institution constituted, licensed, and operated as set forth in the laws that apply to Hospitals, which meets all of the following requirements:

  • Health care practitioner means an individual licensed

  • Utah This Agreement is subject to limited regulation by the Utah Insurance Department. To file a complaint, contact the Utah Insurance Department. Coverage afforded under this Agreement is not guaranteed by the Utah Property and Casualty Guaranty Association. Proof of loss should be furnished by You to the Administrator as soon as reasonably possible. Failure to furnish such notice or proof within the time required by this Agreement does not invalidate or reduce a claim. CANCELLATION section is amended as follows: We can cancel this Agreement during the first sixty (60) days of the initial annual term by mailing to You a notice of cancellation at least thirty (30) days prior to the effective date of cancellation except that We can also cancel this Agreement during such time period for non-payment of premium by mailing You a notice of cancellation at least ten (10) days prior to the effective date of cancellation. After sixty (60) days have elapsed, We may cancel this Agreement by mailing a cancellation notice to You at least ten (10) days prior to the cancellation date for non-payment of premium and thirty (30) days prior to the cancellation date for any of the following reasons: (a) material misrepresentation, (b) substantial change in the risk assumed, unless the We should reasonably have foreseen the change or contemplated the risk when entering into the Agreement or (c) substantial breaches of contractual duties, conditions, or warranties. The notice of cancellation must be in writing to You at Your last known address and contain all of the following: (1) the Agreement number, (2) the date of notice, (3) the effective date of the cancellation and, (4) a detailed explanation of the reason for cancellation. ARBITRATION section is amended to include the following: Any matter in dispute between You and Us may be subject to arbitration as an alternative to court action pursuant to the rules of (the American Arbitration Association or other recognized arbitrator), a copy of which is available on request from Us. Any decision reached by arbitration shall be binding upon both You and Us. The arbitration award may include attorney's fees if allowed by state law and may be entered as a judgment in any court of proper jurisdiction.

  • Community health worker means an individual who:

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Health plan or "health benefit plan" means any policy,

  • AT&T WISCONSIN means the AT&T owned ILEC doing business in Wisconsin.

  • State Forester means the State Forester or the duly authorized representative of the State Forester.

  • AT&T KENTUCKY means the AT&T owned ILEC doing business in Kentucky.

  • Community mental health center or "CMHC" means a facility offering a comprehensive array of community-based mental health services, including but not limited to, inpatient treatment, outpatient treatment, partial hospitalization, emergency care, consultation and education; and, certain services at the option of the center, including, but not limited to, prescreening, rehabilitation services, pre-care and aftercare, training programs, and research and evaluation.

  • New Mexico CANCELLATION section is amended as follows: If You are the original purchaser of this Agreement, You may return this Agreement and receive a refund if: (i) You have not made a claim under the Agreement; and (ii) You return this Agreement within twenty days after the date We mail You a copy of the Agreement or within ten days after You receive a copy of the Agreement if We furnish You with the copy at the time the Agreement is purchased. We may not cancel this Agreement without providing You with written notice at least fifteen (15) days prior to the effective date of cancellation. Such notice shall include the effective date of cancellation and the reason for cancellation. If this Agreement has been in force for a period of seventy (70) days, We may not cancel it before the expiration of the Agreement term or one (1) year, whichever occurs first, unless: 1) You fail to pay any amount due; 2) You are convicted of a crime which results in an increase in the service required under the Agreement; 3) You engage in fraud or material misrepresentation in obtaining this Agreement; or 4) You commit any act, omission, or violation of any terms of this Agreement after the effective date of this Agreement which substantially and materially increases the service required under this Agreement. A ten percent (10%) penalty per month (or each portion thereof) shall be applied to refunds not paid or credited within sixty (60) days of receipt of a returned Agreement.

  • Hospice means a public agency or private organization licensed pursuant to Chapter 400, Florida Statutes, to provide Hospice services. Such licensed entity must be principally engaged in providing pain relief, symptom management, and supportive services to terminally ill Members and their families.

  • ADA means the American Dental Association.

  • health worker means a person who has completed a course of

  • AT&T MICHIGAN means the AT&T owned ILEC doing business in Michigan.

  • Community mental health program means all mental health

  • Georgia means the territory recognised by the international community within the state borders of Georgia, including land territory, internal waters and territorial sea, the air space above them, in respect of which Georgia exercises its sovereignty, as well as the contiguous zone, the exclusive economic zone and continental shelf adjacent to its territorial sea, in respect of which Georgia may exercise its sovereign rights in accordance with the international law;

  • State forest means land dedicated under the Forests Act as a State forest;

  • AT&T OKLAHOMA means the AT&T owned ILEC doing business in Oklahoma.

  • Home Health Care means the continual care and treatment of an individual if:

  • Health professional means an individual licensed or otherwise authorized to engage in a health profession under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838, and whose scope of practice includes the diagnosis and treatment of individuals with a substance use disorder.