Covering Physicians Sample Clauses

Covering Physicians. Physicians agrees to provide or arrange to provide coverage for all Members under the Physician's care twenty-four (24) hours per day, each day of the year. If Physician is, for any reason, from time to time unable to provide Covered Services when and as needed, Physician may secure the services of a qualified physician (the "Covering Physician") who shall render such Covered Services otherwise required of Physician. Covering Physician must be approved by IPA to provide Covered Services to Members and Physician shall notify IPA in advance of Covering Physician providing any services hereunder by giving his or her name, qualifications, address and telephone number and such other pertinent information as shall be required by IPA. Physician shall be solely responsible for securing services of such Covering Physician. It will be Physician's responsibility to ensure that the Covering Physician (i) will not seek reimbursement from the Plan for Covered Services under the terms of this Agreement unless the payment arrangement with the Plan permits the Covering Physician to be paid directly by the Plan for such services, (ii) will abide by IPA's and Plan's policies and procedures including Utilization Management and Quality Management, and (iii) agrees to be bound by all other provisions of this Agreement relating to the delivery of Covered Services. Physician agrees to accept responsibility for costs associated with any deviations of Covering Physician from above requirements.
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Covering Physicians. PCP shall make necessary and appropriate arrangements with Covering Physicians to ensure the availability of Primary Care Services to Members twenty-four (24) hours per day, seven (7) days per week, including arrangements to ensure coverage of Members after hours or when PCP is otherwise unavailable. PCP shall ensure that Covering Physicians are Participating Providers, except as otherwise consented to by VISTA in writing. PCP shall ensure that Covering Physicians adhere to the terms of this Agreement and all VISTA Policies and that Covering Physicians seek required Pre-Authorization from VISTA, or Refer the Member back to PCP, as required by VISTA Policies, except for Emergency Services or Urgently Needed Services or as otherwise permitted under the applicable VISTA Coverage Plan. Except for Hospitalist Physicians (as defined below), with respect to Capitated Services (as defined below), PCP shall be solely liable to Covering Physicians for the amount and manner in which Covering Physicians are reimbursed or otherwise compensated for services rendered to Members on PCP’s behalf. PCP acknowledges and agrees that VISTA shall not have any financial obligation whatsoever to Covering Physicians with respect to Capitated Services. PCP shall ensure that Covering Physicians do not, under any circumstances, bxxx Members for Covered Services other than for applicable Co-Payments, Deductibles and Co-Insurance. PCP hereby agrees to indemnify and hold harmless Members, AHCA, DOI, and CMS against charges for Covered Services rendered by Covering Physicians. All charges incurred for services rendered pursuant to a Pre-Authorization or Referral made by a Covering Physician, other than a Referral back to PCP, shall, unless such Pre-Authorization or Referral was approved by VISTA in advance and in writing or as otherwise permitted under the applicable VISTA Coverage Plan, be borne by PCP who shall be liable for all costs, fees, charges and expenses associated with such services.
Sample 1
Covering Physicians. The Group shall require that Group Physicians provide or arrange to provide coverage for all Members under Group Physicians' care twenty-four (24) hours per day, each day of the year. If a Group Physician is, for any reason, from time to time, unable to provide Covered Services when and as needed, the Group Physician may secure the services of a qualified physician (the "Covering Physician") who shall render such Covered Services otherwise required of the Group Physician. Covering Physician must be approved in writing by IPA to provide Covered Services to Members and the Group shall cause Group Physicians to notify IPA in advance of Covering Physician providing any services hereunder by giving Covering Physician's name, qualifications, address and telephone number and such other pertinent information as shall be required by IPA. The Group agrees that its Group Physicians shall be solely responsible for securing services of such Covering Physician. It will be the Group Physician's responsibility to ensure that the Covering Physician (i) will not seek reimbursement from the Plan for Covered Services under the terms of this Agreement unless the payment arrangement with the Plan permits the Covering Physician to be paid directly by the Plan for such services, (ii) will abide by IPA's and Plan's policies and procedures including Utilization Management and Quality Management, and (iii) agrees to be bound by all other provisions of this Agreement relating to the delivery of Covered Services. The Group agrees to accept responsibility for costs associated with any deviations of Covering Physician from above requirements.
Sample 1

Related to Covering Physicians

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • SKILLED TRADES The Company agrees that maintenance employees are engaged to perform wholly maintenance duties, however, they may perform production duties until the set up or repair has been completed. Also, production employees may catty our minor adjustments and repairs. The Company will establish a tool allowance over the lifetime of this agreement of ($210.00 per contract year) to be used as a credit for the purchase of tools deemed necessary or as required by the Company by all Maintenance Men, Maintenance Machinists and Stationary Engineers In the event an employee eligible for a tool allowance terminates their and has exceeded their allowance of per contract year, then such excess will be withheld from their final earnings. Electronic Technician Electrician Maintenance Maintenance Maintenance Stationary Engineer (Chief) Stationary Engineer Pollution Control Operator Maintenance Trainee Oiler and Greaser Mould Cleaner Stores Roving C Remelt Pot Operator Material Handler Scrap Pickup Oxide Mill Operator Acid Tender Janitor Battery Repair Warehouser Stock Picker Circuit Tender Circuit Tender Commercial Re-Charge Operator Starting rate shall be below published job rate. Publishedjob rate to be effective no later than completion of probationary period. A premium of per hour over the published rate for employees designated as a lead hand by the Company. Base Rate Pasting Machine Operator Off-Bearer Paste Mixing Parting Machine Operator Off-Bearer Forming Room Operator Negative On-Bearedoperator Sinker Assembly Foundry Box Developing Operator Packaging Operator Floater of Jobs Element Burner Sinker Intercell Burner Stacking Operator Off-Bearer Stacking Assembly Burner Battery On-Bearer Place Covers & Mix Resin Inverter Resin Operator Saw Parting CLASSIFICATION SKILLED SEMI-SKILLED * * * Electronic Technician Electrician Maintenance Machinist Maintenance Class Maintenance Class Maintenance Trainee Oiler and Greaser * * * Pollution Control Operator Stationary Engineer Chief Stationary Engineer * Mold Cleaner Stores Machine Operator Off-Bearer Paste Mixing Operator Off-Bearer Operator Negative Ovens Circuit Tender On-Bearer Sinker Assembly SKILLED SEMI-SKILLED * * * * * * * * *

  • Infertility Services This plan covers the following services, in accordance with R.I. General Law §27-20-20. • Services for the diagnosis and treatment of infertility if you are:

  • Contractor Key Personnel ‌ The Contractor shall assign a Corporate OASIS SB Program Manager (COPM) and Corporate OASIS SB Contract Manager (COCM) as Contractor Key Personnel to represent the Contractor as primary points-of-contact to resolve issues, perform administrative duties, and other functions that may arise relating to OASIS SB and task orders solicited and awarded under OASIS SB. Additional Key Personnel requirements may be designated by the OCO at the task order level. There is no minimum qualification requirements established for Contractor Key Personnel. Additionally, Contractor Key Personnel do not have to be full-time positions; however, the Contractor Key Personnel are expected to be fully proficient in the performance of their duties. The Contractor shall ensure that the OASIS SB CO has current point-of-contact information for both the COPM and COCM. In the event of a change to Contractor Key Personnel, the Contractor shall notify the OASIS SB CO and provide all Point of Contact information for the new Key Personnel within 5 calendar days of the change. All costs associated with Contractor Key Personnel duties shall be handled in accordance with the Contractor’s standard accounting practices; however, no costs for Contractor Key Personnel may be billed to the OASIS Program Office. Failure of Contractor Key Personnel to effectively and efficiently perform their duties will be construed as conduct detrimental to contract performance and may result in activation of Dormant Status and/or Off-Ramping (See Sections H.16. and H.17.).

  • Annual Physical The Executive may, if the Executive so elects, within the twelve (12) months following the Date of Termination, receive an annual physical at the Company’s expense consistent with the physical provided under, and subject to the requirements of, the Company’s annual physical program as in effect immediately prior to the Date of Termination.

  • Durable Medical Equipment Durable Medical Equipment is equipment that is Medically Necessary for treatment of an illness or Accidental Injury or to prevent further deterioration. This equipment is designed for repeated use and used to treat a medical condition or illness, and includes items such as oxygen equipment, functional wheelchairs, and crutches. Durable Medical Equipment may require Prior Authorization. Only Durable Medical Equipment considered standard and/or basic as defined by nationally recognized guidelines are Covered.

  • Durable Medical Equipment (DME), Medical Supplies, Prosthetic Devices, Enteral Formula or Food, and Hair Prosthesis (Wigs) This plan covers durable medical equipment and supplies, prosthetic devices and enteral formula or food as described in this section. DME is equipment which: • can withstand repeated use; • is primarily and customarily used to serve a medical purpose; • is not useful to a person in the absence of an illness or injury; and • is for use in the home. DME includes supplies necessary for the effective use of the equipment. This plan covers the following DME: • wheelchairs, hospital beds, and other DME items used only for medical treatment; and • replacement of purchased equipment which is needed due to a change in your medical condition or if the device is not functional, no longer under warranty, or cannot be repaired. DME may be classified as a rental item or a purchased item. In most cases, this plan only pays for a rental DME up to our allowance for a purchased DME. Repairs and supplies for rental DME are included in the rental allowance. Medical supplies are consumable supplies that are disposable and not intended for re- use. Medical supplies require an order by a physician and must be essential for the care or treatment of an illness, injury, or congenital defect. Covered medical supplies include: • essential accessories such as hoses, tubes and mouthpieces for use with medically necessary DME (these accessories are included as part of the rental allowance for rented DME); • catheters, colostomy and ileostomy supplies, irrigation trays and surgical dressings; and • respiratory therapy equipment. This plan covers diabetic equipment and supplies for the treatment of diabetes in accordance with R.I. General Law §27-20-30. Covered diabetic equipment and supplies include: • therapeutic or molded shoes and inserts for custom-molded shoes for the prevention of amputation; • blood glucose monitors including those with special features for the legally blind, external insulin infusion pumps and accessories, insulin infusion devices and injection aids; and • lancets and test strips for glucose monitors including those with special features for the legally blind, and infusion sets for external insulin pumps. The amount you pay differs based on whether the equipment and supplies are bought from a durable medical equipment provider or from a pharmacy. See the Summary of Pharmacy Benefits and the Summary of Medical Benefits for details. Coverage for some diabetic equipment and supplies may only be available from either a DME provider or from a pharmacy. Visit our website to determine if this is applicable or call our Customer Service Department. Prosthetic devices replace or substitute all or part of an internal body part, including contiguous tissue, or replace all or part of the function of a permanently inoperative or malfunctioning body part and alleviate functional loss or impairment due to an illness, injury or congenital defect. Prosthetic devices do not include dental prosthetics. This plan covers the following prosthetic devices as required under R.I. General Law § 27-20-52: • prosthetic appliances such as artificial limbs, breasts, larynxes and eyes; • replacement or adjustment of prosthetic appliances if there is a change in your medical condition or if the device is not functional, no longer under warranty and cannot be repaired; • devices, accessories, batteries and supplies necessary for prosthetic devices; • orthopedic braces except corrective shoes and orthotic devices used in connection with footwear; and • breast prosthesis following a mastectomy, in accordance with the Women’s Health and Cancer Rights Act of 1998 and R.I. General Law 27-20-29. The prosthetic device must be ordered or provided by a physician, or by a provider under the direction of a physician. When you are prescribed a prosthetic device as an inpatient and it is billed by a provider other than the hospital where you are an inpatient, the outpatient benefit limit will apply. Enteral formula or food is nutrition that is absorbed through the intestinal tract, whether delivered through a feeding tube or taken orally. Enteral nutrition is covered when it is the sole source of nutrition and prescribed by the physician for home use. In accordance with R.I. General Law §27-20-56, this plan covers enteral formula taken orally for the treatment of: • malabsorption caused by Crohn’s Disease; • ulcerative colitis; • gastroesophageal reflux; • chronic intestinal pseudo obstruction; and • inherited diseases of amino acids and organic acids. Food products modified to be low protein are covered for the treatment of inherited diseases of amino acids and organic acids. Preauthorization may be required. The amount that you pay may differ depending on whether the nutrition is delivered through a feeding tube or taken orally. When enteral formula is delivered through a feeding tube, associated supplies are also covered. This plan covers hair prosthetics (wigs) worn for hair loss suffered as a result of cancer treatment in accordance with R.I. General Law § 27-20-54 and subject to the benefit limit and copayment listed in the Summary of Medical Benefits. This plan will reimburse the lesser of the provider’s charge or the benefit limit shown in the Summary of Medical Benefits. If the provider’s charge is more than the benefit limit, you are responsible for paying any difference. This plan covers Early Intervention Services in accordance with R.I. General Law §27- 20-50. Early Intervention Services are educational, developmental, health, and social services provided to children from birth to thirty-six (36) months. The child must be certified by the Rhode Island Department of Human Services (DHS) to enroll in an approved Early Intervention Services program. Services must be provided by a licensed Early Intervention provider and rendered to a Rhode Island resident. Members not living in Rhode Island may seek services from the state in which they reside; however, those services are not covered under this plan. Early Intervention Services as defined by DHS include but are not limited to the following: • speech and language therapy; • physical and occupational therapy; • evaluation; • case management; • nutrition; • service plan development and review; • nursing services; and • assistive technology services and devices.

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

  • Hospital This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

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