Benefit Design and Interpretation; Coverage Decisions. PacifiCare shall be solely responsible for the benefit design of all Managed Care Plans, including establishing benefits, Premiums and Copayments. PacifiCare shall be solely responsible for interpreting the terms of and making final coverage determinations under the Managed Care Plans.
Appears in 7 contracts
Samples: Services Agreement (Prospect Medical Holdings Inc), Ipa Services Agreement (Prospect Medical Holdings Inc), Ipa Services Agreement (Prospect Medical Holdings Inc)
Benefit Design and Interpretation; Coverage Decisions. PacifiCare shall be solely responsible for the benefit design of all Managed Care Plans, including establishing benefits, Premiums and Copayments. PacifiCare PacifiCare, or the applicable independent external review agent designated in accordance with applicable State and Federal Law, shall be solely responsible for interpreting the terms of and making final coverage determinations under the Managed Care Plans.
Appears in 2 contracts
Samples: Services Agreement (Prospect Medical Holdings Inc), Services Agreement (Prospect Medical Holdings Inc)
