Availability of Covered Services. Members are entitled to receive the Covered Services set forth in Section 5 and the Attachment A Benefit Schedule subject to all terms and conditions of this AOC, and payment of required premium. These Covered Services are available only if and to the extent that they are:
(a) Provided, prescribed or arranged by the Member's Primary Care Provider (PCP);
(b) Specifically authorized through HPN's Managed Care Program;
(c) Received in HPN’s Service Area, through a Plan Provider; and
(d) Medically Necessary as defined in this AOC. This section does not apply to Emergency Services or Urgently Needed Services as defined in this AOC, or other Covered Services provided by a Non-Plan Provider which have otherwise been approved by HPN’s Managed Care Program.
Availability of Covered Services. Insureds are entitled to receive benefits for the expenses incurred in connection with the Covered Services shown in Section 6 and the Attachment A Benefit Schedule subject to all terms and conditions of this Certificate, and payment of required premium. These Covered Services are available only if and to the extent that they are: Provided or Prescribed by a duly licensed Provider; and Specifically authorized through SHL’s Managed Care Program as applicable; and Medically Necessary as defined in this Certificate. To obtain maximum benefits, Prior Authorization must be received from SHL’s Managed Care Program in order for full benefits to be payable for certain Covered Services. Please read the Certificate and the Attachment B, Services Requiring Prior Authorization, carefully to determine which services require Prior Authorization. This section does not apply to Emergency Services or Urgently Need Services as defined in this Certificate.
Availability of Covered Services. Only licensed personnel with family planning skills, knowledge and competency may provide the full range of family planning medical services covered under Family PACT in accordance with W&I Code, Section 24005(b). Clinical providers electing to participate in the Family PACT Program shall provide the full scope of family planning, education, counseling and medical services specified by Family PACT, either directly or by referral. A client’s selection of contraceptive method(s) shall take into account client preference in conjunction with medical findings.
Availability of Covered Services. Members are entitled to receive the Covered Services set forth in Section 5 and the Attachment A Benefit Schedule subject to all terms and conditions of this AOC, and payment of required premium. These Covered Services are available only if and to the extent that they are:
(a) Provided, prescribed or arranged by the Member's Primary Care Physician (PCP);
(b) Specifically authorized through HPN's Managed Care Program;
(c) Received in HPN’s Service Area, through a Plan Provider; and
(d) Medically Necessary as defined in this AOC. This section does not apply to Emergency Services or Urgently Needed Services as defined in this AOC, or other Covered Services provided by a Non-Plan Provider which have otherwise been approved by HPN’s Managed Care Program. 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. If the medical condition is pregnancy, the 45th day after the date of delivery or if the pregnancy does not end in delivery the date of the end of the pregnancy.
Availability of Covered Services. Provider shall ensure that the Covered Services set forth in Attachment A shall be available to Participants on a twenty-four (24) hours per day, seven (7) day per week basis. Provider shall give (PACE Program) no less than sixty (60) days prior written notice of any changes in Provider Staff or Provider Facilities.
Availability of Covered Services. Doctors Health shall, and shall cause all Participating Providers to, make necessary and appropriate arrangements to ensure that Covered Services are available twenty-four (24) hours per day, seven (7) days per week, including, without limitation, arrangements to ensure coverage after hours or when a particular Participating Provider is otherwise absent, consistent with the Policies and Procedures. For Covered Services, Doctors Health shall, and shall cause all Participating Providers to, make suitable arrangements regarding the amount and manner in which Participating Providers will be compensated.
Availability of Covered Services. Members are entitled to receive the Covered Services set forth in Section 5 and the Attachment A Benefit Schedule subject to all terms and conditions of this AOC, and payment of required premium. These Covered Services are available only if and to the extent that they are:
(a) Provided, prescribed or arranged by the Member's Primary Care Physician (PCP);
(b) Specifically authorized through HPN's Managed Care Program;
(c) Received in HPN’s Service Area, through a Plan Provider; and
(d) Medically Necessary as defined in this AOC. 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: This section does not apply to Emergency Services or Urgently Needed Services as defined in this AOC, or other Covered Services provided by a Non-Plan Provider which have otherwise been approved by HPN’s Managed Care Program.
Availability of Covered Services. Insureds are entitled to receive the Covered Services set forth in Section 6 herein and the Attachment A Benefit Schedule subject to all terms and conditions of this Certificate, and payment of required premium. These Covered Services are available only if and to the extent that they are:
(a) Prescribed by a duly licensed Provider; and;
(b) Medically Necessary as defined in this Certificate.
Availability of Covered Services. Insureds are entitled to receive benefit payments for the Covered Services set forth in Attachment A, Benefit Schedule upon payment of the applicable premium, subject to all terms, conditions, and definitions in the Certificate
Availability of Covered Services. 1. All Family PACT-approved contraceptive methods including all FDA-approved contraceptive methods and their applications, fertility awareness methods, and sterilization procedures, as well as limited infertility services consistent with recognized medical practice standards, shall be made available to clients by the practitioner.
a. At a minimum, the following contraceptive methods shall be provided on-site or by prescription: oral contraceptives; oral emergency contraceptives; contraceptive injection(s); spermicides; male and female condoms, and Lactation Amenorrhea Method (XXX).
b. The following invasive contraceptive procedures and contraceptive methods may be provided on-site or by referral: contraceptive implant(s); intrauterine contraceptives; diaphragm, cervical cap; Fertility Awareness Methods (FAM); and female and male sterilizations.
2. If the practitioner lacks the specialized skills to provide invasive contraceptive procedures or sterilization, or there is insufficient volume to ensure and maintain a high skill level, clients shall be referred to another qualified practitioner for these methods/procedures. The enrolled provider shall have an established referral arrangement with the other provider(s) when making referrals for these procedures.
3. A client’s selection of contraceptive method(s) shall take into account client preference in conjunction with medical findings.
4. Education and counseling about all options and referral resources whether a pregnancy test is positive or negative, shall be provided in an unbiased manner that allows the client full freedom of choice.
5. Screening, testing, and treatment for uncomplicated STIs shall be provided on-site. Clients with complicated STIs may be treated on-site or by referral to a Family PACT or Medi-Cal provider.
6. Screening for cervical cancer by Pap smear shall be provided on-site. Evaluation and treatment of dysplasia may be provided on-site or by referral to a Family PACT or Medi-Cal provider.
7. All services shall be provided to eligible clients without regard to gender, sexual orientation, age (except for sterilization), race, marital status, parity, or disability.
