Coverage Guidelines definition

Coverage Guidelines means guidelines utilized by BCBSF to determine eligibility for payment and payment levels, including (but not limited to) medical coverage guidelines, utilization management protocols and policies, and inpatient and/or outpatient review criteria.
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Examples of Coverage Guidelines in a sentence

  • Provider Manual: Gender Dysphoria PDF Version of Coverage Guidelines Adult Day Health Day programs for frail seniors and other adults who need supervision and health services during the daytime.

  • These Coverage Guidelines applies only to Claims first made, Investigations first commenced, Inquiries first received and Books and Records Demands first received during the Coverage Guidelines Period anywhere in the world as permitted by law.

  • The particulars and statements contained in the Application are incorporated into and constitute a part of these Coverage Guidelines.

  • The right to purchase the Optional Extension Period shall terminate in the event written notice together with full payment of the premium for the Optional Extension Period is not given to Coverage Provider within thirty (30) days after the Coverage Guidelines expiration date.

  • Notice to any agent or knowledge possessed by any agent or other person acting on behalf of Coverage Provider shall not effect a waiver or a change in any part of these Coverage Guidelines or estop Coverage Provider from asserting any right under the terms of these Coverage Guidelines, nor shall the terms be waived or changed except by written endorsement or rider issued by Coverage Provider to form a part of these Coverage Guidelines.

  • If the Company elect to seek coverage for Books and Records Costs in connection with a Books and Records Demand, the Company shall give to Coverage Provider notice in writing of such Books and Records Demand, but in no event later than sixty (60) days after the end of the Coverage Guidelines Period, the Predetermined Run-Off Period or the Optional Extension Period (if purchased).

  • In respect of Insuring Clause I.A., the failure of any of the Insured Persons or the Company to give Coverage Provider or their counsel the information, assistance and cooperation that they may reasonably request, shall not impair the rights of any other Insured Person under these Coverage Guidelines.

  • If both Loss covered by these Coverage Guidelines and loss uncovered by these Coverage Guidelines are incurred, either because the Claim, Investigation or Inquiry includes both covered and uncovered allegations or because it includes both insured and uninsured parties, then the Insureds and Coverage Provider agree to use their best efforts to fairly and reasonably allocate such amount between covered Loss and uncovered loss.

  • The Coverage Provider assume no duty to seek a recovery of any amounts paid under these Coverage Guidelines.

  • The following terms whenever used in these Coverage Guidelines in boldface type shall have the meanings indicated.