Common use of Availability of Covered Services Clause in Contracts

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. 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. 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 Programas 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 Programin order for full benefits to t o be payable for certain Covered Services. Please read the Certificate and the Attachment B, Services Requiring Prior AuthorizationAut horization, 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.