Common use of Availability of Covered Services Clause in Contracts

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. 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 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.

Availability of Covered Services. Members are entitled to receive the Covered Services set forth in Section 5 6 herein and the Attachment A Benefit Schedule subject to all terms and conditions of this AOCEOC, and payment of required premium. These Covered Services are available only if and to the extent that they are: (a) a. Provided, prescribed or arranged by the Member's Primary Care Provider (PCP); (b) b. Specifically authorized through HPN's Managed Care Program; (c) c. Received in HPN’s Service Area, Area through a Plan Provider; and (d) d. Medically Necessary as defined in this AOCEOC. This section does not apply to Emergency Services or Urgently Needed Services as defined in this AOCEOC, or other Covered Services provided by a Non-Plan Provider which have otherwise been approved by HPN’s Managed Care Program.