MHCN Facility definition

MHCN Facility. A facility (hospital, medical center or health care center) owned, operated or otherwise designated by the MHCN. MHCN Personal Physician: A provider who is employed by or contracted with the MHCN to provide primary care services to Members and is selected by each Member to provide or arrange for the provision of all non-emergent Covered Services, except for services set forth in the Agreement which a Member can access without a Referral. MHCN Provider: The medical staff, clinic associate staff and allied health professionals employed by the MHCN and any other health care professional or provider with whom the MHCN has contracted to provide health care services to Members enrolled under the Agreement, including, but not limited to, physicians, podiatrists, nurses, physician assistants, social workers, optometrists, psychologists, physical therapists and other professionals engaged in the delivery of healthcare services who are licensed or certified to practice in accordance with Title 18 Revised Code of Washington. Out-of-Pocket Expenses: Those Cost Shares paid by the Subscriber or Member for Covered Services which are applied to the Out-of-Pocket Limit. Out-of-Pocket Limit: The maximum amount of Out-of-Pocket Expenses incurred and paid during the calendar year for Covered Services received by the Subscriber and his/her Dependents within the same calendar year. The Out-of- Pocket Limit amount and Cost Shares that apply are set forth in the Allowances Schedule. Charges in excess of Plan Coinsurance: The percentage amount the Member and GHO are required to pay for Covered Services received under the Agreement. Percentages for Covered Services are set forth in the Allowances Schedule. Pre-Existing Condition: A condition for which there has been diagnosis, treatment or medical advice within the three (3) month period prior to the effective date of coverage. The Pre-Existing Condition wait period will begin on the first day of coverage, or the first day of the enrollment waiting period if earlier. Preferred Community Provider: A Community Provider that has agreed to accept from GHO a contracted rate for Covered Services under Section IV. Services received from a Preferred Community Provider are subject to a discounted rate, less any Cost Shares set forth in the Allowances Schedule. Preferred Community Provider Contracted Rate: The discounted rate that the Preferred Community Provider has agreed to accept from GHO for medical services received by Members. Referra...
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MHCN Facility. A facility (hospital, medical center or health care center) owned, operated or otherwise designated by the MHCN.
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Examples of MHCN Facility in a sentence

  • If a Member is hospitalized in a non-MHCN Facility, GHO reserves the right to require transfer of the Member to a MHCN Facility, upon consultation between a MHCN Provider and the attending physician.

  • If Members cannot get to a MHCN Facility, Members may obtain Emergency services from the nearest hospital.

  • Coverage for Emergency care in a non-MHCN Facility and subsequent transfer to a MHCN Facility is set forth in Section IV.L.

  • MHCN-initiated non-emergent transfers to or from a MHCN Facility are covered as set forth in the Allowances Schedule.

  • Transfer to another MHCN Facility if transferability is medically possible as determined by the MHCN.

  • If the Member is admitted to a MHCN Facility directly from the emergency room, the Emergency care Copayment is waived.

  • If the Member refuses to transfer to a MHCN Facility, all services received will be covered under the Community Provider option of the Inpatient Hospital Services section set forth in the Allowances Schedule.

  • MHCN: Routine eye examinations and refractions received at a MHCN Facility once every twelve (12) months, except when Medically Necessary.

  • Ambulance Services MHCN: Covered at 80% for transport to a MHCN Facility.

  • If the Member refuses to transfer to a MHCN Facility, all services received Urgent Care (See Section VIII.