Common use of Amount, Duration and Scope of Coverage Clause in Contracts

Amount, Duration and Scope of Coverage. Contractor shall comply with the terms of 42 C.F.R. §438.206(b) and provide or arrange to have provided to all Enrollees services described in 89 Ill. Adm. Code, Part 140 as amended from time to time and not specifically excluded therein in accordance with the terms of this Contract. Covered Services shall be provided in the amount, duration and scope as set forth in 89 Ill. Adm. Code, Part 140 and this Contract, and shall be sufficient to achieve the purposes for which such Covered Services are furnished. This duty shall commence at the time of initial coverage as to each Enrollee. Contractor shall, at all times, cover the appropriate level of service for all Emergency Services and non-Emergency Services in an appropriate setting. Contractor shall notify Department in writing as soon as practicable, but no later than five (5) days, following a change in Contractor’s network of Affiliated Providers that renders Contractor unable to provide one (1) or more Covered Services within the access to care standards set forth in Section 5.6. Contractor shall not refer Enrollees to publicly supported health care entities to receive Covered Services for which Contractor receives payment from the Department, unless such entities are Affiliated Providers with Contractor. Such publicly supported health care entities include, but are not limited to, Chicago Department of Public Health and its clinics, Cook County Bureau of Health Services, and Certified Local Health Departments. Contractor shall provide a mechanism for an Enrollee to obtain a second opinion from a qualified Provider, whether Affiliated or non-Affiliated, at no cost to the Enrollee. Contractor will assist in coordinating obtaining any second opinion from a non-Affiliated Provider. Covered Services will be phased in as three

Amount, Duration and Scope of Coverage. Contractor shall comply with the terms of 42 C.F.R. §438.206(b) and provide or arrange to have provided to all Enrollees services described in 89 Ill. Adm. Code, Part 140 as amended from time to time and not specifically excluded therein in accordance with the terms of this Contract. Covered Services shall be provided in the amount, duration and scope as set forth in 89 Ill. Adm. Code, Part 140 and this Contract, and shall be sufficient to achieve the purposes for which such Covered Services are furnished. This duty shall commence at the time of initial coverage as to each Enrollee. Contractor shall, at all times, cover the appropriate level of service for all Emergency Services and non-Emergency Services in an appropriate setting. Contractor shall notify Department in writing as soon as practicable, but no later than five (5) days, following a change in Contractor’s network of Affiliated Providers that renders Contractor unable to provide one (1) or more Covered Services within the access to care standards set forth in Section 5.6. Contractor shall not refer Enrollees to publicly supported health care entities to receive Covered Services for which Contractor receives payment from the Department, unless such entities are Affiliated Providers with Contractor. Such publicly supported health care entities include, but are not limited to, Chicago Department of Public Health and its clinics, Cook Xxxx County Bureau of Health Services, and Certified Local Health Departments. Contractor shall provide a mechanism for an Enrollee to obtain a second opinion from a qualified Provider, whether Affiliated or non-Affiliated, at no cost to the Enrollee. Contractor will assist in coordinating obtaining any second opinion from a non-Affiliated Provider. Covered Services will be phased in as three

Amount, Duration and Scope of Coverage. The Contractor shall comply with the terms of 42 C.F.R. §438.206(b) and provide or arrange to have provided to all Enrollees all services described in 89 Ill. Adm. Code, Part 140 as amended from time to time and not specifically excluded therein or in this Article V, Section 5.1 in accordance with the terms of this Contract. Covered Services shall be provided in the amount, duration and scope as set forth in 89 Ill. Adm. Code, Part 140 and this Contract, and shall be sufficient to achieve the purposes for which such Covered Services are furnished. This duty shall commence at the time of initial coverage as to each Enrollee. The Contractor shall, at all times, cover the appropriate level of service (i.e., triage, urgent) for all Emergency Services and non-Emergency Services provided in an appropriate emergency room setting. The Contractor shall notify the Department in writing as soon as practicable, but no later than within five (5) days, days following a change in the Contractor’s network of Affiliated Providers that renders the Contractor unable to provide one (1) or more Covered Services within the access to care standards set forth Service(s) in Section 5.6any Contracting Area. The Contractor shall not refer Enrollees to publicly supported health care entities to receive Covered Services Services, for which the Contractor receives payment from the Department, unless such entities are Affiliated Providers with the Contractor’s Plan. Such publicly supported health care entities include, but are not limited to, Chicago Department of Public Health and its clinics, Cook County Bureau of Health Services, Services and Certified Local Health Departmentslocal health departments. The Contractor shall provide a mechanism for an Enrollee to obtain a second opinion from a qualified Provider, whether Affiliated or non-Affiliated, at no cost to the Enrollee. Contractor will assist in coordinating obtaining any second opinion from a non-Affiliated Provider. Covered Services will be phased in as three.

Amount, Duration and Scope of Coverage. The Contractor shall comply with the terms of 42 C.F.R. §438.206(b) and provide or arrange to have provided to all Enrollees all services described in 89 Ill. 111. Adm. Code, Part 140 as amended from time to time and not specifically excluded therein or in this Article V, Section 5.1 in accordance with the terms of this Contract. Covered Services shall be provided in the amount, duration and scope as set forth in 89 Ill. 111. Adm. Code, Part 140 and this Contract, and shall be sufficient to achieve the purposes for which such Covered Services are furnished. This duty shall commence at the time of initial coverage as to each Enrollee. The Contractor shall, at all times, cover the appropriate level of service (i.e., triage, urgent) for all Emergency Services and non-Emergency Services provided in an appropriate emergency room setting. The Contractor shall notify the Department in writing as soon as practicable, but no later than within five (5) days, days following a change in the Contractor’s 's network of Affiliated Providers that renders the Contractor unable to provide one (1) or more Covered Services within the access to care standards set forth Service(s) in Section 5.6any Contracting Area. The Contractor shall not refer Enrollees to publicly supported health care entities to receive Covered Services Services, for which the Contractor receives payment from the Department, unless such entities are Affiliated Providers with the Contractor's Plan. Such publicly supported health care entities include, but are not limited to, Chicago Department of Public Health and its clinics, Cook Xxxx County Bureau of Health Services, and Certified Local Health Departmentslocal health departments. The Contractor shall provide a mechanism for an Enrollee to obtain a second opinion from a qualified Provider, whether Affiliated or non-Affiliated, at no cost to the Enrollee. Contractor will assist in coordinating obtaining any second opinion from a non-Affiliated Provider. Covered Services will be phased in as threeto

Amount, Duration and Scope of Coverage. The Contractor shall comply with the terms of 42 C.F.R. §438.206(b) and provide or arrange to have provided to all Enrollees all services described in 89 Ill. 111. Adm. Code, Part 140 as amended from time to time and not specifically excluded therein or in this Article V, Section 5.1 in accordance with the terms of this Contract. Covered Services shall be provided in the amount, duration and scope as set forth in 89 Ill. 111. Adm. Code, Part 140 and this Contract, and shall be sufficient to achieve the purposes for which such Covered Services are furnished. This duty shall commence at the time of initial coverage as to each Enrollee. The Contractor shall, at all times, cover the appropriate level of service (i.e., triage, urgent) for all Emergency Services and non-Emergency Services provided in an appropriate emergency room setting. The Contractor shall notify the Department in writing as soon as practicable, but no later than within five (5) days, days following a change in the Contractor’s 's network of Affiliated Providers that renders the Contractor unable to provide one (1) or more Covered Services within the access to care standards set forth Servicc(s) in Section 5.6any Contracting Area. The Contractor shall not refer Enrollees to publicly supported health care entities to receive Covered Services Services, for which the Contractor receives payment from the Department, unless such entities are Affiliated Providers with the Contractor's Plan. Such publicly supported health care entities include, but are not limited to, Chicago Department of Public Health and its clinics, Cook County Bureau of Health Services, and Certified Local Health Departmentslocal health departments. The Contractor shall provide a mechanism for an Enrollee to obtain a second opinion from a qualified Provider, whether Affiliated or non-Affiliated, at no cost to the Enrollee. Contractor will assist in coordinating obtaining any second opinion from a non-Affiliated Provider. Covered Services will be phased in as three.