Closed panel plan definition

Closed panel plan means a plan that provides health benefits to covered persons primarily in the form of services through a panel of providers that have contracted with or are employed by the plan, and that excludes benefits for services provided by other providers, except in cases of emergency or referral by a panel member.

Closed panel plan means a health care plan that requires enrollees to use participating providers.

Closed panel plan means a plan that provides dental care benefits to Members primarily in the form of services through a panel of dental care providers that have contracted with or are employed by the plan, and that excludes coverage for services provided by other dental care providers, except in cases of emergency or referral by a panel member.

Examples of Closed panel plan in a sentence

• Closed panel plan is a plan that provides health care benefits to covered persons in the form of services through a panel of providers who are primarily employed by the plan, and that excludes coverage for services provided by other providers, except in cases of Emergency or referral by a panel member.

• Examples of these types of situations are major medical coverages that are superimposed over base plan hospital and surgical benefits, and insurance type coverages that are written in connection with a Closed panel plan to provide out-of-network benefits.

• Closed panel plan is a Plan that provides health care benefits to Members primarily in the form of services through a panel of providers that have contracted with or are employed by the Plan, and that excludes coverage for services provided by other providers, except in cases of emergency or referral by a panel member.

• If an Insured Person is enrolled in two or more Closed panel plans and if, for any reason, including the provision of service by a non-panel provider, benefits are not payable by one Closed panel plan, COB shall not apply between that Plan and other Closed panel plans.

• Closed panel plan is a Plan that provides health care benefits to Insured Persons primarily in the form of services through a panel of providers that have contracted with or are employed by the Plan, and that excludes coverage for services provided by other providers, except in cases of emergency or referral by a panel member.

More Definitions of Closed panel plan

Closed panel plan means a Plan that provides medical or dental benefits primarily in the form of services through a panel of employed or contracted providers, and that limits or excludes benefits provided by providers outside of the panel, except in the case of emergency or if referred by a provider within the panel.

Closed panel plan means a plan that provides vision care benefits to Covered Persons primarily in the form of services through a panel of vision care Providers that have contracted with or are employed by the plan, and that excludes coverage for services provided by other vision care Providers, except in cases of emergency or referral by a panel member.

Closed panel plan means a plan that provides health care benefits to Members primarily in the form of services through a panel of health care providers that have contracted with or are employed by the plan, and that excludes coverage for services provided by other health care providers, except in cases of emergency or referral by a panel member.

Closed panel plan means a health care plan that requires enrollees to use participating providers. "Open panel plan" means a health care plan that provides incentives for enrollees to use participating providers and that also allows enrollees to use providers that are not participating providers. (R.C. 1751.01(E) and (S)(1), not in the bill.) No health insuring corporation may offer an open panel plan, unless the health insuring corporation is also licensed as an insurer under the Insurance Law, the health insuring corporation, on June 4, 1997, holds a certificate of authority or license to operate under R.C. Chapter 1736. or 1740. (both chapters have been repealed), or an insurer licensed under the Insurance Law is responsible for the out-of-network risk as evidenced by both an evidence of coverage filing under R.C. 1751.11 (evidence of subscriber's coverage for health care plan under which health care benefits are provided) and a policy and certificate filing under R.C. 3923.02 (sickness and accident insurance policy or certificate). (R.C. 1751.01(S)(2), not in the bill.)

Closed panel plan means a Plan that provides health benefits to covered persons primarily in the form of services through a panel of providers that have contracted with or are employed by the Plan, and that limits or excludes benefits for services provided by a non-panel provider, except in cases of an Out-of- Area Emergency defined as being outside the Plan's service area.

Closed panel plan means a health care plan that

Closed panel plan means a plan that provides health benefits to covered persons primarily in the form of services through a panel of providers that have contracted with or are employed by the plan, and that excludes benefits for