Covered Services in Special Circumstances definition

Covered Services in Special Circumstances means Covered Services provided by a Medical Group Participating Provider following termination to a Member who is undergoing a course of treatment from the Participating Provider for an acute condition, serious chronic condition, high-risk pregnancy, or a pregnancy that has reached the second or third trimester at the time of termination. The foregoing definition shall be interpreted in a manner consistent with applicable law, including California Health and Safety Code Section 1373.96.
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Examples of Covered Services in Special Circumstances in a sentence

  • Without limiting any other provision of this Agreement, all of Medical Group’s subcontracts shall contain the requirements set forth at Sections 8.3.3 of this Agreement pertaining to the provision of Covered Services in Special Circumstances.

  • Following termination of this Agreement, Medical Group shall, at the request of the applicable Member and in accordance with PacifiCare’s policies and procedures, assure that all of its Participating Providers shall provide Covered Services in Special Circumstances to Members as required by this Section 8.3.3.

  • In the event of termination of this Agreement, Medical Group shall provide information to PacifiCare to identify Members who may be eligible for Covered Services in Special Circumstances from a Medical Group Participating Provider.

  • Without limiting any other provision of this Agreement, all of Medical Group’s subcontracts shall contain the requirements set forth in Sections 8.3.3 of this Agreement pertaining to the provision of Covered Services in Special Circumstances and shall provide that Medical Group’s Participating Providers shall look solely to Medical Group for payment for Covered Services provided to Medical Group Members.

  • Following the termination of any Medical Group Participating Provider, Medical Group shall, at the request of the applicable Member and in accordance with PacifiCare’s policies and procedures, assure that such Participating Provider shall provide Covered Services in Special Circumstances to Members as required by this Section 8.3.3.

  • Medical Group shall be solely responsible for compensating any terminated Participating Provider for the provision of Covered Services in Special Circumstances to Members as agreed upon in writing between the terminated Participating Provider and Medical Group or at the rate and method of payment used by Medical Group for its contracting providers providing similar services who are not capitated and who are practicing in the same or a similar geographic area as the terminated Participating Provider.

  • Following the enrollment of a New Member into a PacifiCare health plan, Medical Group shall, at the request of such New Member and in accordance with PacifiCare’s policies and procedures, assure that the applicable Nonparticipating Provider shall provide Covered Services in Special Circumstances to New Members as required by this Article IV.

  • Following the Termination of any Participating Provider, Medical Group shall, at the request of the applicable Member and in accordance with PacifiCare’s policies and procedures, assure that such Participating Provider shall provide Covered Services in Special Circumstances as required by this Article IV.

  • Medical Group shall be solely responsible for compensating any terminated Participating Provider for the provision of Covered Services in Special Circumstances to Members as agreed upon in writing between the terminated Participating Provider and Medical Group or at the rate and method of payment used by Medical Group for its contracting providers providing similar services who are not capitated and who arc practicing in the same or a similar geographic area as the terminated Participating Provider.

  • Following the Termination of the Agreement, Medical Group shall at the request of the applicable Member and in accordance with PacificCare’s policies and procedures, assure that all of its Participating Providers shall provide Covered Services in Special Circumstances to Members as required by this Article IV.

Related to Covered Services in Special Circumstances

  • Special Circumstances means either or both of the following:

  • Covered Services means all or a part of those medical and health services set forth in rule 441—86.14(514I).

  • Exceptional Circumstances means disclosure:

  • Unforeseen Circumstances means changes in circumstances affecting a Covered Species or the Covered Lands that could not reasonably have been anticipated by the Parties at the time of the HCP’s negotiation and development, and that result in a substantial and adverse change in the status of the Covered Species.

  • Special Circumstance means an event where, in the opinion of the Bank acting reasonably and in good faith, an amendment or a change is made to a taxation act or regulation, to taxation practices, policies or administration, to the interpretation of a taxation act or regulation or taxation practice, policy or administration; or an event occurs, now or in future, caused by circumstances beyond the control of the Bank making it illegal or disadvantageous, from a legislative or regulatory point-of-view, or disadvantageous, from a financial point- of-view, for the Bank to allow the Deposits of such series to remain outstanding. As provided hereunder, certain other extraordinary events affecting the underlying interest may be deemed to constitute a Special Circumstance and entitle the Bank to proceed with a Reimbursement Under Special Circumstances.

  • Exigent Circumstances means circumstances where collection or disclosure is urgently necessary, such that procedures that would otherwise be required cannot be followed.

  • Disaster Recovery Services means the Services embodied in the processes and procedures for restoring the provision of Services following the occurrence of a Disaster, as detailed further in Call Off Schedule 8 (Business Continuity and Disaster Recovery);

  • Information Service Traffic means Local Traffic or IntraLATA Toll Traffic which originates on a Telephone Exchange Service line and which is addressed to an information service provided over a Party's information services platform (e.g., 976).

  • Scope of Services or “Scope of Work” means the work to be performed by the Proposer or Consultant as described in Section 2.0 of this RFP, as amended thereto.

  • Transition Services Agreements means the transition services agreements between the Purchaser and one or more of the Sellers in substantially the forms attached hereto as Exhibit D and Exhibit E.

  • Business Continuity and Disaster Recovery Plan means the Schedule containing plans and provisions for business continuity and disaster recovery.

  • Hosted Services means the hosting, management and operation of the computing hardware, ancillary equipment, Software, firmware, data, other services (including support services), and related resources for remote electronic access and use by the State and its Authorized Users, including any services and facilities related to disaster recovery obligations.

  • Basic generation service transition costs means the amount by

  • Transition Services Agreement means the transition services agreement, dated as of the Closing Date, to be entered into by the Seller and the Buyer, substantially in the form of Exhibit G.

  • Extraordinary Circumstances means floods, snow, ice storms, tornadoes, earthquakes, or other

  • Covered Personnel means any Person who is or was an employee, consultant or independent contractor of the Covered Parties, as of such date of the relevant act prohibited by this Section 2(a) or during the one (1) year period preceding such date.

  • Material Change in Content means the occurrence since the Launch Date of a material change in the content, composition or constitution of the Futures Contract or the Commodity.

  • Specified Personnel means the personnel specified in the Contract to provide the Services.

  • Dependent Care Expenses means employment-related expenses incurred on behalf of a person who meets the requirements to be a "Qualifying Individual," as defined in the first bulleted item below. All of the following conditions must be met for such expenses to qualify as Dependent Care Expenses that are eligible for reimbursement: