AMERIGROUP and Associate have mutually agreed that Associate shall separate from AMERIGROUP, effective as of the close of business on April 1, 2007 (the “End Date”).
AMERIGROUP. Pasco and Polk Page 1 of 2 Effective Date: January 1, 2003 All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment is hereby made a part of this contract.
AMERIGROUP. 3-1 Benefits 3-2 Access to Care 3-2-1 Access and Appointment Standards 3-2-2 Integrity of Professional Advice to Enrollees 3-3 Fraud and Abuse 3-4 Marketing Materials 3-5 Use of Name 3-6 Eligibility 3-7 Effective Date of Coverage 3-8 Termination of Participation 3-9 Continuation of Coverage Upon Termination of this Agreement 3-10 Individual Contracts 3-11 Refusal of Coverage 3-12 Extended Coverage 3-13 Grievances and Complaints 3-14 Claims Payment 3-15 Notification 3-16 Rates 3-16 Rate Modification 3-16-1 Annual Adjustment 3-16-2 Denial of Rate Request 3-18 Conditions of Services 3-19 Medical Records Requirements 3-19-1 Medical Quality Review and Audit AMERIGROUP Effective Date: October 1, 2003 - September 30, 2005
AMERIGROUP must also comply with the guidance issued by the Office of Civil Rights of the United States Department of Health and Human Services ("Policy Guidance on the Title VI Prohibition against National Origin Discrimination as it Effects Persons with Limited English Proficiency") regarding the availability of information and assistance for persons with limited English proficiency. AMERIGROUP Effective Date: October 1, 2003 - September 30, 2005 EXHIBIT C ENROLLEE BENEFIT SCHEDULE
I. Minimum Benefits; Statutory Requirements AMERIGROUP agrees to provide, at a minimum, those benefits that are prescribed by state law under Section 409.815(2)(a-p) and 409.815 (r-t). AMERIGROUP shall pay an enrollees' covered expenses up to a lifetime maximum of $1 million per covered enrollee. The following health care benefits are included under this Agreement: ------------------------------------------------------------------------------------------------------------------- BENEFIT LIMITATIONS CO-PAYMENTS -------------------------------------------------------------------------------------------------------------------
A. Inpatient Services All admissions must be authorized by AMERIGROUP. NONE All covered services provided for The length of the patient stay shall be determined based on the medical care and treatment the medical condition of the enrollee in relation to of an enrollee who is admitted the necessary and appropriate level of care. as an inpatient to a hospital licensed under part I of Chapter 395. Room and board may be limited to semi-private accommodations, Covered services include: unless a private room is considered medically necessary physician's services; or semi-private accommodations are not available. room and board; general Private duty nursing limited to circumstances where nursing care; patient meals; such care is medically necessary. use of operating room and Admissions for rehabilitation and physical therapy are limited related facilities; use of to 15 days per contract year. intensive care unit and Shall Not Include Experimental or Investigational Procedures as services; radiological, defined as a drug, biological product, device, medical treatment laboratory and other or procedure that meets any one of the following criteria, diagnostic tests; drugs; as determined by AMERIGROUP. medications; biologicals;
1. Reliable Evidence shows the drug, biological product, device, anesthesia and oxygen medical treatment, or procedure when applied to the services; speci...
AMERIGROUP is responsible for informing its providers of these provisions and ensuring that enrollees under this section incur no further out of pocket costs for covered services and are not denied access to services. FHKC will provide these enrollees with a letter indicating that they may not incur any cost sharing obligations.
