Benefit Package and Non-covered Services Descriptions Sample Clauses

Benefit Package and Non-covered Services Descriptions. Due to the fact that at the time of the execution of this Agreement PRHIA has not received the approved PBP from CMS, all the terms and conditions of this Agreement are subject to PRIHA determination (at its sole discretion) that the PBP complies with all the requirements of Medicare Platino 2012 adopted by PRHIA. If PRHIA determines that the PBP does not comply with Platino 2012 requirements, the CONTRATOR is responsible to request the necessary changes and obtain final approval from CMS. Until PRHIA determines, and confirms to the CONTRATOR in writing that the PBP complies with all the requirements, the CONTRATOR will be prohibited from conducting any soliciting, enrollment or publication of any marketing material. The Medicare Platino Benefit Package and Non-Covered Services agreed to by the Contractor and the PRHIA are contained in: Appendix C-1 (13) • Appendix C-2 (13) • Appendix C-3 (13)- Appendix C-4 (13) Medicare Advantage Product (PBP) submitted toCMS Medicaid Wraparound Services not covered by Medicare Platino but provided by the Department of Health which are hereby made a part of this agreement as if set forth fully herein. Summary of Benefits Report - The Summary Benefits (SB) included as Appendix C-4 (13) was submitted by the Medicare Advantage Organization (MAO) and has yet to be Appendix C-5 (13) Appendix C-6 (13) Appendix C-7 (13) approved by PRHIA Compliance Office. The Parties agree that the inclusion of the SB does not mean that the same have already been approved and that, if necessary, changes could be requested. Therefore, since the SB needs the approval of the PRIHA, this Section could be amended subject to PRHIA, review. Coordinated Care Model Norms 2013 Certification Co-payments Certifications Benefit Non-Covered by Wrap-Around and Value Added Benefits Certification
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Benefit Package and Non-covered Services Descriptions. The Medicare and Medicaid Advantage Benefit Packages and Non-Covered Services agreed to by the Contractor and the SDOH are contained in Appendix K, which is hereby made a part of this Agreement as if set forth fully herein.
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Benefit Package and Non-covered Services Descriptions. Due to the fact that at the time of the execution of this Agreement PRHIA has not received the approved PBP from CMS, all the terms and conditions of this Agreement are subject to PRIHA determination (at its sole discretion) that the PBP complies with all the requirements of Medicare Platino 2011 adopted by PRHIA. If PRHIA determines that the PBP does not comply with Platino 2011 requirements, the CONTRATOR is responsible to request the necessary changes and obtain final approval from CMS. Until PRHIA determines, and confirms to the CONTRATOR in writing that the PBP complies with all the requirements, the CONTRATOR will be prohibited from conducting any soliciting, enrollment or publication of any marketing material. The Medicare Platino Benefit Package and Non-Covered Services agreed to by the Contractor and the PRHIA are contained in:
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Related to Benefit Package and Non-covered Services Descriptions

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following: 1. All non-medically necessary services; 2. Sterilization of a mentally incompetent or institutionalized individual; 3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition; 4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility5 and for the reversal of sterilization;

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Grandfathered Services Services identified in GTE Tariffs as grandfathered in any manner are available for resale only to end user customers that already have such grandfathered service. An existing end user customer may not move a grandfathered service to a new service location. Grandfathered services are subject to a resale discount.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • Compensation for Providing Information The Party requesting Information agrees to reimburse the other Party for the reasonable out-of-pocket costs, if any, of creating, gathering and copying such Information, to the extent that such costs are incurred for the benefit of the requesting Party.

  • SPECIALIZED SERVICE REQUIREMENTS In the event that the Participating Entity requires service or specialized performance requirements not addressed in this Contract (such as e- commerce specifications, specialized delivery requirements, or other specifications and requirements), the Participating Entity and the Supplier may enter into a separate, standalone agreement, apart from this Contract. Sourcewell, including its agents and employees, will not be made a party to a claim for breach of such agreement.

  • Detailed Description of Services / Statement of Work Describe fully the services that Contractor will provide, or add and attach Exhibit B to this Agreement.

  • Service Level Agreements If a Service or a Plan includes a Service Level Agreement (SLA): (a) we are liable for any remedy or rebate specified by the SLA; and (b) subject to clauses 40 to 42, and to the express terms of the SLA, our liability for breach of the SLA is limited to such remedy or rebate.

  • Attachment A, Scope of Services The scope of services is amended as follows:

  • Service Level Expectations Without limiting any other requirements of the Agreement, the Service Provider shall meet or exceed the following standards, policies, and guidelines:

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