Plan Medical Group definition

Plan Medical Group or "PMG" means a group of physicians, organized as or contracted through a legal entity, that has met Plan's criteria for participation and has entered into an agreement with Plan to provide and make available Professional Services, and to provide or coordinate the provision of other Benefits to Members and that is included in the selected Plan Network.
Sample 1Sample 2Sample 3

Examples of Plan Medical Group in a sentence

  • We conduct this evaluation independently by interpreting the provisions of this EOC.Relations Among Parties Affected By This Group Agreement and EOCKaiser Permanente is comprised of three entities: the Health Plan, Medical Group and Plan Hospitals.

  • The relationship between them is explained immediately below.Relations Among Parties Affected By This AgreementKaiser Permanente is comprised of three entities: the Health Plan, Medical Group and Plan Hospitals.

  • Neither the Health Plan, Medical Group nor any Plan Physicians have any liability or obligation extending from any Service or benefit sought or received by a Member from any non-Plan:1.

  • The disputed health care service has been denied, modified or delayed by the Plan or a Plan Medical Group, based in whole or in part on a decision that the health care service is not Medically Necessary; and3.

  • Your PCP or other Plan Provider is responsible for requesting Authorization from Sharp Health Plan or your Plan Medical Group.

  • Independent Medical Reviews (IMR)If care that is requested for you is denied, delayed or modified by Sharp Health Plan or a Plan Medical Group, you may be eligible for an Independent Medical Review (IMR).

  • Relations Among Parties Affected By This Group Agreement and EOCKaiser Permanente is comprised of three entities: the Health Plan, Medical Group and Plan Hospitals.

  • Relations Among Parties Affected By This Group Agreement and EOCKaiser Permanente is comprised of three entities: The Health Plan, Medical Group and Plan Hospitals.

  • Denial of a Health Care Service as Not Medically NecessaryYou may request an Independent Medical Review of disputed health care services from the DMHC if you believe that health care services have been improperly denied, modified, or delayed by Sharp Health Plan or a Plan Medical Group.

  • Denial of Experimental or Investigational treatment for Life-Threatening or Seriously Debilitating ConditionsIf a service is denied by Sharp Health Plan or a Plan Medical Group because it is deemed to be an Experimental or Investigational Service, you may be entitled to request an IMR of this decision.

Related to Plan Medical Group

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • Pharmacy benefits management means the administration or management of prescription drug

  • Insurance holding company system means a group of two or more affiliated persons, at least one of whom is an insurer.

  • Medical Foods means any nutritional substances in any form that are:

  • Group health plan means an employee welfare benefit plan as defined in section 3(1) of subtitle A of title I of the employee retirement income security act of 1974, Public Law 93-406, 29 USC 1002, to the extent that the plan provides medical care, including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement, or otherwise.

  • School-sponsored media means all student media that are:

  • Medical care means amounts paid for:

  • Odyssey means Odyssey Trust Company.

  • Gap medical benefits means the benefits (if any) payable in respect of medical expenses that are less than, greater than or equal to the schedule fee, provided always that the medical expenses relate to a professional service that:

  • Medical Executive Committee or “MEC” means the Executive Committee of the Medical Staff.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • 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:

  • Medical home means a team approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient’s family; utilizes the partnership to access and integrate all medical and nonmedical health-related services across all elements of the health care system and the patient’s community as needed by the patient and the patient’s family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care; and has all of the characteristics specified in section 135.158.

  • ITT means the Purchaser’s invitation to tender dated (date ITT issued).

  • Non-Administrator Hospital means a Hospital that does not meet the definition of an Administrator Hospital.

  • Care Plan means a licensee's written description of a resident's needs, preferences, and capabilities, including by whom, when, and how often care and services are to be provided.

  • Critical group means the group of individuals reasonably expected to receive the greatest exposure to residual radioactivity for any applicable set of circumstances.

  • Medical history means information regarding any:

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

  • Pharmacy benefits manager means a person that performs pharmacy benefits management.

  • Executive Management means the CEO and the CFO for purposes of administering this Plan.

  • Emergency medical care means such medical procedures as:

  • Risk retention group means any corporation or other limited liability association:

  • Asset Management Plan means a plan created by the department and approved by the state transportation commission or a plan created by a local road agency and approved by the local road agency's governing body that includes provisions for asset inventory, performance goals, risk of failure analysis, anticipated revenues and expenses, performance outcomes, and coordination with other infrastructure owners.

  • Medical cannabis card means the same as that term is defined in Section 26-61a-102.

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.