Expedited Review. In disciplinary matters, dismissal and termination actions may be expedited to arbitration by either the Union or the Employer.
Expedited Review. If you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or if you are undergoing a current course of treatment using a non-formulary drug, you can request an expedited review. We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 24 hours following receipt of your request. If our initial determination is overturned, we will provide coverage for the PrEP medication or PrEP related service that is medically appropriate for you for the duration of the treatment. For more information or assistance with your complaint, grievance or an exception request, you may contact the Managed Health Care Bureau (MHCB) of the Office of Superintendent of Insurance at: Telephone: 0-000-000-0000 Office of Superintendent of Insurance-MHCB X.X. Xxx 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 E-mail: xxxx.xxxxxxxxx@xxxxx.xx.xx This endorsement is retroactive back to the effective date of your coverage with us, or January 1, 2022, whichever comes first. These items replace and supersede any conflicting provision of your insurance contract and summary of benefits and coverage. All other requirements of the policy not in conflict with this endorsement still apply. Table of Contents Welcome 13 Welcome to Presbyterian Health Plan! 13 Our Agreement with You 13 Understanding This Agreement 14 Customer Assistance 15 Member Rights and Responsibilities 17 This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. Member Rights 17 Additional Member Rights and Responsibilities 18 Consumer Advisory Board 20 How the Plan Works 21 This section explains how to find Practitioners/Providers who are in our Network (In- network), get Healthcare Services both In-network and Out-of-network, requirements you must follow when getting care and how to receive Covered Benefits under this Agreement. Provider Directory 22 Obtaining Healthcare 22 How to Obtain a PCP 22 Women’s Healthcare Provider/Practitioner 22 Specialist Care 23 Obtaining Care after Normal Provider Office Hours 23 In-Network Practitioners/Providers 23 Out-of-Network Practitioners/Providers 24 Restrictions on Services Received Outside of the PHP Service Area 26 Out-Of-Network Care And Bills 26 If you pay an Out-of-network Provider more than we determine you owe: 27 Restrictions on Services Received Outside of t...
Expedited Review. In disciplinary matters, the Union and the Employer may agree to expedite the grievance directly to arbitration.
Expedited Review. If you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or if you are undergoing a current course of treatment using a non-formulary drug, you can request an expedited review. We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 24 hours following receipt of your request. If our initial determination is overturned, we will provide coverage for the PrEP medication or PrEP related service that is medically appropriate for you for the duration of the treatment. For more information or assistance with your complaint, grievance or an exception request, you may contact the Managed Health Care Bureau (MHCB) of the Office of Superintendent of Insurance at: Address: Office of Superintendent of Insurance Managed Health Care Bureau P.O. Box 1689 Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-000-0000 Fax: (000) 000-0000 Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Routine Immunizations Routine Immunization includes Coverage for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of: The Advisory Committee on Immunization Practices Centers for Disease Control and Prevention. The U.S. Preventive Services Task Force (USPSTF) o HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).
Expedited Review. In the event a Disputed Matter concerns any matter that has material economic, risk or compliance implications to Bank, Retailer or the Program, including the Cardholder Terms or the risk management policies (a “Material Issue”), either Bank or Retailer may request an expedited review of such Material Issue (an “Expedited Review”). Expedited Review shall consist of the following procedures:
Expedited Review. Under the circumstances below, City shall cooperate to expedite the development design review process, building plan review process, improvement plan review process, and the entitlement review process for the developments to be located on the Property. Review of any application through an expedited process as provided by this subparagraph shall not be deemed to waive any of the Applicable Rules pertaining to review or approval of such application, including, but not limited to, a public hearing, if any, required therefore. Should developer request review of any application through an expedited process, and should City agree, Developer authorizes the imposition of fees paid to the City beyond the permit/plan review fees allowed by Millbrae’s Municipal Code, in an amount sufficient to cover City’s estimated costs of utilizing additional City staff or retaining an outside consultant or any combination thereof in order to expedite the review process during the Term.
Expedited Review a. Subject to Section 8.02 above, the internal appeals process must allow for expedited review. If a Member requests an expedited review, the MCO must determine within one business day of receipt of the request, whether to expedite the review or whether to perform the review according to the standard timeframes.
Expedited Review. In the event a Party requests Expedited Review of a Disputed Matter, such changes relating to such Disputed Matter shall not be implemented by a Party until the completion of the review process set forth in this Section 4.9 (“Expedited Review”) and the Parties have approved such changes; provided, however, that a Party may immediately implement any change required by Applicable Law or as necessary to prevent fraud after sending notice to the other Parties describing the change and its rationale for such change. Disputed Matters subject to Expedited Review are subject to the following procedures:
Expedited Review. A foreign board of trade may request an expedited Commission review and determination of whether a futures contract on a se- curity index that trades, or is proposed to be traded thereon, conforms to the requirements of section 2(a)(1)(C)(ii) of the Act and therefore, may be offered or sold to persons in the U.S. under section 2(a)(1)(C)(iv) of the Act. A sub- mission requesting such expedited con- sideration should be filed in English with the Commission and should in- clude: Information, statements and data complying with the form and con- tent requirements in paragraph (a) of this section.
Expedited Review. An expedited initial determination will be used if your attending health care professional believes it is warranted. Acute care services, which can warrant expedited review, are medical care or treatment with respect to which the application of the time periods for making non-expedited review determinations could seriously jeopardize your life or health or your ability to regain maximum function, or that in the opinion of your attending health care professional would subject you to severe pain that cannot be adequately managed without the care or treatment that is the subject of the pre- service claim. An expedited initial determination will be provided to you, your attending health care professional, hospital (if applicable) and attending provider as quickly as your medical condition requires, but no later than 72 hours following the initial request. If PIC does not have all information it needs to make a determination, you will be notified within 24 hours. You will then have at least 48 hours to provide the requested information. You, your attending health care professional, hospital (if applicable) and attending provider will be notified of the determination within 48 hours after the earlier of PIC’s receipt of the requested information or the end of the time period specified for you to provide the requested information. If the initial determination would deny coverage, you or your attending health care professional will have the right to submit an expedited appeal Note: If your request is denied, you may appeal that decision. Refer to the section entitled “Internal Appeals Process” for details on how to appeal. Case Management In cases where your condition is expected to be or is of a serious nature, PIC may arrange for review and/or case management services from a professional who understands both medical procedures and PIC’s health care coverage. Under certain conditions, XXX will consider other care, services, supplies, reimbursement of expenses or payments for care of your serious sickness or injury that would not normally be covered. PIC and your physician will determine whether any medical care, services, supplies, reimbursement of expenses or payments will be covered. Such care, services, supplies, reimbursement of expenses or payments will not be considered as setting any precedent or creating any future liability. Other care, treatments, services, or supplies must meet both of these tests:
