Description of Covered Services. Subject to the Exclusions, conditions and limitations specified in this Agreement, a Member shall be entitled to receive the Covered Services listed below. A Member may be required to make a Copayment or there may be limits on services and other cost sharing requirements as specified in the Section SC - Schedule Of Cost Sharing of this Agreement. Most Covered Services are provided or arranged by a Member’s Primary Care Physician. In the event there is no Participating Provider to provide the specialty or subspecialty services that a Member needs, a Referral to a Non- Participating Provider will be arranged by the Member’s Primary Care Physician, with approval by the HMO. See Section ACC - Access to Primary, Specialist and Hospital Care Network for procedures for obtaining Preauthorization for use of a Non-Participating Provider. If a Member should have questions about any information in this Agreement or need assistance at any time, they should contact Keystone by calling the telephone number shown on their ID Card. Some Covered Services must be Preauthorized before a Member receives the services. The Primary Care Physician or Participating Specialist must seek the HMO's approval and confirm that coverage is provided for certain services. Preauthorization of services is a vital program feature that reviews Medical Necessity of certain procedures and/or admissions. In certain cases, Preauthorization helps determine whether a different treatment may be available that is equally effective yet less traumatic. Preauthorization also helps determine the most appropriate setting for certain services. If a Primary Care Physician or Participating Specialist provides Covered Services or Referrals without obtaining such Preauthorization, the Member will not be responsible for payment. More information on Preauthorization is found in Section MC - Using the HMO System of this Agreement and the Medical Care Preauthorization Schedule attached to this Agreement.
Description of Covered Services. Subject to the Exclusions and Limitations hereinafter stated, the following is a brief Description of Covered Dental Services when such services are rendered by a licensed dentist and when necessary and customary, as determined by the standards of generally accepted dental practice: This program pays the following percent of the Usual, Customary and Reasonable Fees.
Description of Covered Services. During the term of this Agreement, IdentiSys agrees to provide the preventative and remedial maintenance services recommended by the manufacturer. IdentiSys technicians will perform maintenance services, at the scheduled frequency, sufficient to keep equipment in good operating condition. Maintenance services include necessary replacement of standard parts, and labor necessary to replace such parts, to make technical adjustments, and to clean and lubricate the equipment at the scheduled frequency.
Description of Covered Services. Subject to the exclusions and limitations hereinafter stated, the following is a brief description of covered dental ser- vices when such services are rendered by a licensed dentist and when necessary and customary, as determined by the standards of generally accepted dental practice: This pro- gram pays the following percent of the Usual, Customary and Reasonable Fees
Description of Covered Services. Identification of Prospects and the initiation of business relationships between such Prospects and GoFish with a view towards generating Sales; · Promotion of the Websites, both with respect to creating and increasing user awareness of and interest in such portals, creating awareness of such portals to the advertising and media communities, arranging “partnerships” for generation of meaningful traffic to such portals and the like; and · Promotion of the Company and/or GoFish as a possible merger/acquisition partner with a view towards acquisitions by the Company of appropriate targets or the Sale of the Company, including identifying prospective merger/acquisition partners, making appropriate introductions and assisting the Company and/or GoFish with respect to negotiations of possible merger/acquisition transactions or the Sale of the Company.
Description of Covered Services. CareSource shall make available a description of Covered Services through the CareSource’s Provider Website, and/or other methods of communication as deemed appropriate by CareSource or as required by Law.
Description of Covered Services. Subject to the exclusions, conditions and limitations of the Agreement, a Participant is entitled to Covered Services described in the Agreement, in accordance with the Deductible, Copayment and Coinsurance, if any, and in the amounts as specified herein and in the Outline of Coverage. The Outline of Coverage also specifies the Benefit Period selected by the Plan. The Participant is always responsible for Copayments, Deductibles and Coinsurance in the amounts shown for Covered Services as included herein, in the Outline of Coverage that accompanies the Agreement. Pre-Certification requirements must be followed as discussed in Section CC - Care Coordination. Emergency admissions must be reviewed within forty-eight (48) hours of the admission, or as soon as reasonably possible. A concurrent review is required for any continued length of stay beyond what has been Pre-Certified by First Priority Life.
