Agreement of Member. Each Member entitled to receive Covered Services under this Plan agrees to: Choose a PCP from the list of available PCPs. The Subscriber and each Dependent may select a different PCP. A female Member may choose two (2) PCPs: A general practice Physician and an Obstetrician or Gynecological Physician. Members may receive benefits only as provided by or approved in advance by the chosen PCP. Receive specialty consultation and/or treatment from Plan Physicians only upon written Prior Authorization according to HPN’s Managed Care Program. Obtain Prior Authorization from HPN’s Managed Care Program before receiving any non-Emergency Services from Non-Plan Providers. Be financially responsible for the cost of services in excess of EME when these services are approved by HPN’s Managed Care Program and received outside of HPN’s Service Area or from Non-Plan Providers. Except in the case of Emergency Services and Urgently Needed Services, be fully responsible for the cost of services not provided by the PCP according to HPN’s Managed Care Program or Prior Authorized by the PCP or HPN’s Managed Care Program. Provide at least twenty-four (24) hours prior notice of cancellation of an appointment with a Provider. Make timely payment of Copayment amounts due to Providers.
Agreement of Member. Each Member entitled to receive Covered Services under this Plan agrees to: • Choose a PCP from the list of available PCPs. The Subscriber and each Dependent may select a different PCP. • A female Member may choose two (2) PCPs: A general practice Physician and an Obstetrician or Gynecological Physician. Members may receive benefits only as provided by or approved in advance by the chosen PCP. • Receive specialty consultation and/or treatment from Plan Physicians only upon written Prior Authorization according to HPN’s Managed Care Program. • Obtain Prior Authorization from HPN’s Managed Care Program before receiving any non-Emergency Services from Non-Plan Providers. • Be financially responsible for the cost of services in excess of EME when these services are approved by HPN’s Managed Care Program and received outside of HPN’s Service Area or from Non-Plan Providers. • Except in the case of Emergency Services and Urgently Needed Services be fully responsible for the cost of services not provided by the PCP according to HPN’s Managed Care Program or Prior Authorized by the PCP or HPN’s Managed Care Program. • Provide at least twenty-four (24) hours prior notice of cancellation of an appointment with a Provider.
Agreement of Member. Phone: Health Plan of Nevada, Inc. Attn: Provider Services Dept. X.X. Xxx 00000 Xxx Xxxxx, XX 00000-0000 Each Member entitled to receive Covered Services under this Plan agrees to: • Choose a PCP from the list of available PCPs. The Subscriber and each Dependent may select a different PCP. • A female Member may choose two (2) PCPs: A general practice Physician and an Obstetrician or Gynecological Physician. Members may receive benefits only as provided by or approved in advance by the chosen PCP. • Receive specialty consultation and/or treatment from Plan Physicians only upon written Prior Authorization according to HPN’s Managed Care Program. • Obtain Prior Authorization from HPN’s Managed Care Program before receiving any non-Emergency Services from Non-Plan Providers. • Be financially responsible for the cost of services in excess of EME when these services are approved by HPN’s Managed Care Program and received outside of HPN’s Service Area or from Non-Plan Providers. • Except in the case of Emergency Services and Urgently Needed Services be fully responsible for the cost of services not provided by the PCP according to HPN’s Managed Care Program or Prior Authorized by the PCP or HPN’s Managed Care Program. • Provide at least twenty-four (24) hours prior notice of cancellation of an appointment with a Provider. • Make timely payment of Copayment amounts due to Providers.
Agreement of Member. Address: Health Plan of Nevada, Inc. Attn: Provider Services Dept. P.O. Box 15645 Las Vegas, NV 89114-5645 Receive specialty consultation and/or treatment from Plan Physicians only upon written Prior Authorization according to HPN’s Managed Care Program. Obtain Prior Authorization from HPN’s Managed Care Program before receiving any non-Emergency Phone: (000) 000-0000 0-000-000-0000
Agreement of Member. The Member or Plan Provider may submit a request for continuity of care to the address shown below. If the Plan agrees to the continued treatment, the Plan will pay for Covered Services at the Plan Provider level of benefits for a limited time, as outlined above. The Plan Provider may not seek payment from the Member for any amounts for which the Member would not be responsible if the Provider were still a Plan Provider. Address: Health Plan of Nevada, Inc. Attn: Provider Services Dept. P.O. Box 15645 Las Vegas, NV 00000-0000 Phone: Obtain Prior Authorization from HPN’s Managed Care Program before receiving any non-Emergency Services from Non-Plan Providers. Be financially responsible for the cost of services in excess of EME when these services are approved by HPN’s Managed Care Program and received outside of HPN’s Service Area or from Non-Plan Providers. Except in the case of Emergency Services and Urgently Needed Services be fully responsible for the cost of services not provided by the PCP according to HPN’s Managed Care Program or Prior Authorized by the PCP or HPN’s Managed Care Program. Provide at least twenty-four (24) hours prior notice of cancellation of an appointment with a Provider. Make timely payment of Copayment amounts due to Providers. Termination of a Plan Provider’s contract will not release the Provider from treating a Member, except for reasons of medical incompetence or professional misconduct as determined by HPN. Coverage provided under this section is available until the latest of the following dates: The 120th day following the date the contract was terminated between the Provider and HPN; or
