Benefit Plan Descriptions. Medical Group will participate in the network of physicians and other health care professionals and providers established by United (“Participating Providers”) for the Benefit Plan types described below: • Benefit Plans where Customers are offered a network of Participating Providers and must select a Primary Physician. Such Benefit Plans may or may not include an out-of-network benefit. • Benefit Plans where Customers are offered a network of Participating Providers but are not required to select a primary physician. Such Benefit Plans may or may not include an out-of-network benefit. • Benefit Plans where Customers are not offered a network of Participating Providers from which they may receive Covered Services. Notwithstanding the above, this Agreement does not apply to the following: • Capitation arrangements are when all of the following apply:
Benefit Plan Descriptions. Facility will participate in the network of physicians and other health care professionals and providers established by United (“Participating Providers”) for the Benefit Plan types described below: • Benefit Plans where Customers are offered a network of Participating Providers and must select a Primary Physician. Such Benefit Plans may or may not include an out-of-network benefit. • Benefit Plans where Customers are offered a network of Participating Providers but are not required to select a primary physician. Such Benefit Plans may or may not include an out-of-network benefit. • Benefit Plans where Customers are not offered a network of Participating Providers from which they may receive Covered Services. • [Benefit plans or programs serviced by OneNet PPO, LLC] • [Benefit Plans sponsored, issued or administered by any Payer where the Benefit Plan is intended to replace, either partially or in its entirety, the traditional Medicare coverage (Medicare Part A and Medicare Part B) issued to beneficiaries by the Centers for Medicare and Medicaid Services.] • [Medicare Advantage Private Fee-For-Service plans.] Facility will not participate in the network of physicians and other health care professionals and providers established by United for the Benefit Plan types described below: • [Benefit plans or programs serviced by OneNet PPO, LLC] • [Benefit Plans for Medicaid Customers (Note: excluding Medicaid from this Agreement does not preclude the parties or their affiliates from having a separate agreement pertaining to participation in a Medicaid network).] • [Benefit Plans for Medicaid Customers] • [Benefit Plans for workers’ compensation benefit programs] • [Benefit Plans for Medicare Select.] UnitedHealthcare Facility Agreement Confidential and Proprietary UHC/FPA[ANC][State][Nat’l].08.07 0507 * Confidential Treatment Requested by Celera Corporation*
Benefit Plan Descriptions. Section 1. United may allow Payers to access Facility’s services under this Agreement for the Benefit Plan types described in each line item below, unless otherwise specified in section 2 of this Appendix 2: - Benefit Plans where Customers are offered a network of participating providers and must select a primary physician, who in some cases must approve any care provided by other health care providers. Such Benefit Plans may or may not include an out-of-network benefit. - Benefit Plans where Customers are offered a network of participating providers but are not required to select a primary physician. Such Benefit Plans may or may not include an out-of- network benefit. - Benefit Plans where Customers are not offered a network of participating providers from which they may receive Covered Services. - Medicare Advantage Benefit Plans. -
Benefit Plan Descriptions. Section 1. United may allow Payers to access Medical Group’s services under this Agreement for the Benefit Plan types described in each line item below, unless otherwise specified in section 2 of this Appendix 2: - Benefit Plans where Customers are offered a network of participating providers and must select a primary physician, who in some cases must approve any care provided by other health care providers. Such Benefit Plans may or may not include an out-of-network benefit. - Benefit Plans where Customers are offered a network of participating providers but are not required to select a primary physician. Such Benefit Plans may or may not include an out-of- network benefit. - [Benefit Plans where Customers are not offered a network of participating providers from which they may receive Covered Services.] - [Medicare Advantage Benefit Plans.] - [New Mexico Centennial Care Benefit Plans.]
Benefit Plan Descriptions. Facility will participate in the network of physicians and other health care professionals and providers established by United (“Participating Providers”) for the Benefit Plan types described below: [* * *] UnitedHealthcare Facility Agreement Confidential and Proprietary UHC/FPA[ANC][State][Nat’l].08.07 0507 * Confidential Treatment Requested by Celera Corporation*
Benefit Plan Descriptions. Medical Group will participate in the network of physicians and other health care professionals and providers established by United (“Participating Providers”) for the Benefit Plan types described below: • Medicare Benefit Plans that (A) are sponsored, issued or administered by any Payer and (B) replace, either partially or in its entirety, the original Medicare coverage (Medicare Part A and Medicare Part B) issued to beneficiaries by the Centers for Medicare and Medicaid Services (“CMS”), other than Medicare Advantage Private Fee-For-Service Plans. • QUEST Expanded Access (QExA) Medicaid Benefit Plans administered by United’s business unit UnitedHealthcare Dual Complete, as indicated by a reference to UnitedHealthcare Dual Complete on the face of the valid identification card of any Customer eligible for and enrolled in such Benefit Plan. Medical Group will not participate in the network of physicians and other health care professionals and providers established by United for the Benefit Plan types described below. • This Agreement does not apply to commercial products and will not be amended to apply to commercial products. However, the parties may mutually agree, at some time in the future, to replace this Agreement with a new agreement that includes commercial products and that is in a form, and on terms and conditions, substantially similar to the form and terms and conditions of this Agreement. • Medicare Advantage Private Fee-For-Service Plans. • Medicaid Benefit Plans. Appendix 3 Representative Medicare Fee Schedule Sample Representative Medicare Fee Schedule Sample 2008 Fee Sched – HI Physician In Office Procedures/Visits (HI 9297) Fee Schedule Sample for All Specialties and HI 100% NON 2008 Fee Sched – HI – Hospital Based Procedures/Visits (HI 9298) Fee Schedule Sample for All Specialties and HI 100% NON The provisions of this fee schedule apply to services rendered by Medical Group to Medicare Customers covered by Medicare Benefit Plans that (A) are sponsored, issued or administered by any Payer and (B) replace, either partially or in its entirety, the original Medicare coverage (Medicare Part A and Medicare Part B) issued to beneficiaries by the Centers for Medicare and Medicaid Services (“CMS”), other than Medicare Advantage Private Fee-For-Service Plans. The provisions of this fee schedule do not apply to services Medical Group renders to Medicare beneficiaries pursuant to a commercial Benefit Plan. United will use best efforts to update the ...
Benefit Plan Descriptions. Section 1. United may allow Payers to access Facility’s services under this Agreement for the Benefit Plan types described in each line item below, unless otherwise specified in section 2 of this Appendix 2: - [Benefit Plans where Customers are offered a network of participating providers and must select a primary physician, who in some cases must approve any care provided by other health care providers. Such Benefit Plans may or may not include an out-of-network benefit. ] - [Benefit Plans where Customers are offered a network of participating providers but are not required to select a primary physician. Such Benefit Plans may or may not include an out-of- network benefit.] - [Benefit Plans where Customers are not offered a network of participating providers from which they may receive Covered Services.] - [Group PPO Medicare Advantage Benefit Plans.] - [Medicare Advantage Benefit Plans.] - [Ohio Medicare and Medicaid Enrollees (MME) Benefit Plans.] - [Ohio Medicaid Benefit Plans.] - [Hoosier Care Connect Medicaid Benefit Plans.] - [Kentucky Medicaid and CHIP Benefit Plans.] - [Michigan Medicaid Benefit Plans and Michigan CHIP Benefit Plans, including but not limited to Michigan Children’s Special Health Care Services Benefit Plans.] - [Pennsylvania Medicaid Benefit Plans.] - [Pennsylvania CHIP Benefit Plans.] - [Individual Exchange Benefit Plans.] - [Additional Network Benefit Plans. As used here Additional Network Benefit Plans means commercial narrow network Benefit Plan types in which Facility does not participate, as described in section 2 of this Appendix 2, but that provide for an additional network of providers for outpatient emergency services, inpatient services following an emergency admission, urgent care services and services pre-approved by United. Additional Network Benefit Plan types will be identified by the notation “W500” on the Customer’s ID card. United may modify this ID card notation in the future, and will provide Facility with the updated information.]
