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: Medical Group/Ipa Services Agreement (Prospect Medical Holdings Inc), Medical Group Services Agreement (Prospect Medical Holdings Inc), Medical Group/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 1 contract
Samples: Professional Capitation Medical Group/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.
4. The following Sections of the Agreement are hereby deleted and replaced in their entirety, to read as follows:
Appears in 1 contract
Samples: Medical Group/Ipa Services Agreement (Prospect Medical Holdings Inc)
