Coverage for Services Provided Sample Clauses

Coverage for Services Provided. Outside Our Service Area Overview BCBSRI has a variety of relationships with other Blue Cross and/or Blue Shield Licensees. Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross and Blue Shield Association (“Association”). Whenever you access healthcare services outside the geographic area BCBSRI serves, the claim for those services may be processed through one of these Inter-Plan Arrangements, as described below. When you receive care outside of the BCBSRI service area, you will receive it from one of two kinds of providers. Most providers (“participating providers”) contract with the local Blue Cross and/or Blue Shield Plan in that geographic area (“Host Blue”). Some providers (“nonparticipating providers”) don’t contract with the Host Blue. We explain below how we pay both kinds of providers.
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Coverage for Services Provided. Outside Our Service Area Overview BCBSRI has a variety of relationships with other Blue Cross and/or Blue Shield Licensees. Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross and Blue Shield Association (“Association”). Whenever you access healthcare services outside the geographic area BCBSRI serves, the claim for those services may be processed through one of these Inter-Plan Arrangements, as described below. When you receive care outside of the BCBSRI service area, you will receive it from one of two kinds of providers. Most providers (“participating providers”) contract with the local Blue Cross and/or Blue Shield Plan in that geographic area (“Host Blue”). Some providers (“nonparticipating providers”) don’t contract with the Host Blue. We explain below how we pay both kinds of providers. This plan covers only limited healthcare services received outside of the service area. As used in this section, “Out-of-Area covered healthcare services” include the following services obtained outside the geographic area we serve: Emergency care (emergency room, urgent care center and ambulance services); services for which we specifically approve the use of a non-network provider; and otherwise, as required by law. Any other services will not be covered when processed through any Inter-Plan Arrangements unless authorized by us. Inter-Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all dental benefits, and those prescription drug benefits or vision benefits that may be administered by a third party contracted by us to provide the specific service or services. BlueCard® Program Under the BlueCard® Program, when you receive covered healthcare services within the geographic area served by a Host Blue, BCBSRI will remain responsible for doing what we agreed to in the contract. However, the Host Blue is responsible for contracting with and generally handling all interactions with its participating providers. When you receive covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for covered healthcare services is calculated based on the lower of: • the billed covered charges for your covered services; or • the negotiated price that the Host Blue makes available to BCBSRI. The BlueCard Prog...
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Related to Coverage for Services Provided

  • Fee for Services In consideration of the Services rendered by the Contractor and subject to clause 6.3 below, the Union shall pay to the Contractor a fee (the “Fee”) at the rate of and in the manner specified in the Schedule to this Agreement. The fee for service/s will be agreed in writing for the length of the agreement and will be reviewed at the organisations discretion and schedule, annually as a minimum. The Contractor shall submit monthly to the Union an invoice on, or as soon as reasonably possible after, the last day of each month detailing the Services (number of hours) provided within that month. The invoice shall show any value added tax separately. The Union may deduct from any sums payable to the Contractor any sums that the Contractor owes to the Union. If notice of termination is given under clause 13 and the Union does not require the Contractor to provide the Services during the notice period the Fee shall cease to accrue on the date upon which notice of termination was given. Upon termination of this Agreement under clause 13, the Contractor shall be entitled to receive payment of the Fee accrued only to the end of the day on which termination occurs. The Contractor shall be responsible for all day to day personal expenses incurred in the performance of the Services. If the Contractor is unable to provide the Services for any reason the Contractor shall not be entitled to receive any Fee in respect of that period of unavailability.

  • Warranty for Services Vendor warrants that the Services will be performed (i) in a diligent, professional and workmanlike manner in accordance with the highest applicable industry standards, (ii) in accordance with the requirements under this Agreement, and (iii) by experienced, qualified and properly trained and appropriately licensed personnel. If Vendor fails to meet the specifications as set forth herein, Vendor will, without additional compensation, promptly correct or revise any errors or deficiencies in the Services provided.

  • For Services It is expected that, where services can be furnished by multiple sources (e.g. Contractor and/or Resellers), each source may offer different rates for the same service. Rates offered by each multiple source cannot exceed Contractor’s ceiling rate for that type/category. The parties may, upon mutual agreement expressed in the Purchase Order, agree to more advantageous payment or financing schedules.

  • Contracting for Services It is the intent of the parties to preserve the work and job opportunities of the employees covered by this agreement. It is also, however, an obligation as well as a management prerogative of the employer to maintain the efficiency of the employer's operations and to determine methods and means by which those operations are to be conducted. The employer shall make every reasonable effort to retain the employees covered by this agreement and will not make arrangements to contract with any outside firm for any of the services ordinarily rendered by said employees which would jeopardize their continued employment without disclosure to the bargaining agent sufficiently in advance to accommodate discussion between the parties of the contemplated action. The employer shall not enter into any such contract for services unless it can be proven that said contract would result in increased efficiency of operations by way of obtaining the same services at less cost or additional services for the same cost, or unless it can be proven that such action is necessitated by financial exigency. The employer agrees it shall be a condition of any such contract for services which may displace employees covered herein, that the contractor shall offer employment to as many of said employees who would be displaced by said contract as the number of similarly qualified employees who shall be required by the contractor to effect performance of the contract. It is understood, however, that the employer may not require the terms of the contractor's offer of employment to be identical to or commensurate with those of the employee's contract with the employer. The provisions of this paragraph are subject to the grievance procedure and no work which would result in displacement of any employee within the bargaining unit shall be contracted prior to a final decision on any grievance filed under the terms of this contract.

  • Fees for Services The compensation of the Subadviser for its services under this Agreement shall be calculated and paid by the Adviser in accordance with the attached Schedule C. Pursuant to the Investment Advisory Agreement between the Fund and the Adviser, the Adviser is solely responsible for the payment of fees to the Subadviser.

  • Charges for Services (a) It is the intention of the parties that the charges for the Services provided under this Agreement be determined in accordance with fair and reasonable standards and that no party realize a profit nor incur a loss as a result of the Services rendered pursuant to this Agreement.

  • Reimbursement for Services Rendered If this Agreement is held to be invalid for any reason, and the PRACTICE is required to refund fees paid by You, You agree to pay the PRACTICE an amount equal to the fair market value of the medical services You received during the time period for which the refunded fees were paid.

  • Services Provided Subcontractor agrees to complete the following: _ (“Services”).

  • Contract for Services The parties intend this Agreement to be a contract for the provision of services and not a contract for the sale of goods. To the fullest extent permitted by law, the provisions of the Uniform Commercial Code (UCC), the Uniform Computer Information Transaction Act (UCITA), the United Nations Convention on Contracts for the International Sale of Goods, and any substantially similar legislation as may be enacted, shall not apply to this Agreement.

  • Compensation for Services You may be eligible to receive compensation for providing certain services in respect of Shares of the Funds if you meet the requirements of and enter into a Dealer Services Agreement with American Funds Service Company.

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