Direct Access Specialist Benefits Sample Clauses

Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of covered Infertility services. 1. if Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam every 24 Months period. 2. if Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam every 24 Months period. 3. if Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam every 24 Months period. 4. if Member is age 46 and over and does not wear eyeglasses or contact lenses, 1exam every 24 Months period.
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Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. 1. if the Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam(s) every 12-month period. 2. if the Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam(s) every 24-month period. 3. if the Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam(s) every 36-month period. 4. if the Member is age 46 and over and does not wear eyeglasses or contact lenses, 1 exam(s) every 24-month period.
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Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of Infertility benefits. • Direct Access to Participating Optometrists and Ophthalmologists for Medical Emergency. Member will be covered for up to two (2) visits, one initial and one follow-up visit, without referral from PCP. The Optometrist or Ophthalmologist will submit a report containing the Member’s complaint, history, exam results, initial diagnosis and treatment recommendations to the Member’s PCP within three (3) working days. HMO and Member will not be liable for any services rendered if the Provider fails to submit this report within three (3) working days. 1. if the Member is age 1 through 18, 1 exam every 24-month period. 2. if the Member is age 19 and over, 1 exam every 24-month period.
Sample 1Sample 2
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Dermatologists. Benefits are provided for Members for dermatological services performed by a Participating Dermatologist limited to office visits, minor procedures and testing. The number of visits, if any, is listed on the Schedule of Benefits. • Routine Gynecological Examination(s) and Open Access to Gynecologists. Routine gynecological visit(s) and pap smear(s). The number of visits, if any, is listed on the Schedule of Benefits. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. See the Infertility Services section of this Certificate for a description of Infertility benefits. • Direct Access to Chiropractors. Benefits are provided for Members for chiropractic services performed by a Participating Chiropractor limited to office visits, minor procedures and testing. The number of visits, if any, is listed on the Schedule of Benefits. • Direct Access to Podiatrists. Benefits are provided for Members for podiatry services performed by a Participating Podiatrist limited to office visits, minor procedures and testing. The number of visits, if any, is listed on the Schedule of Benefits. 1. if Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam every 12- month period. 2. if Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam every 24- month period. 3. if Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam every 36-month period. 4. if Member is age 46 and over and does not wear eyeglasses or contact lenses, 1 exam every 24-month period.
Sample 1Sample 2
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. 1. if the Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam every 12-month period. 2. if the Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam every 24-month period. 3. if the Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam every 36-month period. 4. if the Member is age 46 and over and does not wear eyeglasses or contact lenses, 1 exam every 24-month period.
Sample 1
Direct Access Specialist Benefits. 1. The following services are covered without a Referral when rendered by a Participating Provider other than the Member’s PCP. The Member must select a Participating gynecologist or obstetrician in her PCP’s Medical Group or IPA. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. 2. Routine Eye Examinations are covered as shown below without a Referral when rendered by a a. if Member is age 1 through 18 and wears eyeglasses or contact lenses, 1 exam(s) every 12-month period. b. if Member is age 19 and over and wears eyeglasses or contact lenses, 1 exam(s) every 24-month period. c. if Member is age 1 through 45 and does not wear eyeglasses or contact lenses, 1 exam(s) every 36-month period. d. if Member is age 46 and over and does not wear eyeglasses or contact lenses, 1 exam(s) every 24-month period.
Sample 1
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Women’s Health Care Specialists. Benefits are provided to female Members for services performed by a Participating Women’s Health Care Specialist for preventive gynecological care, diagnosis and treatment of gynecological problems, maternity care, and reproductive services to the extent they are covered under this Certificate. If the Member self- refers to a Participating Women’s Health Care Specialist for one of the conditions listed above, and the Participating Women’s Health Care Specialist diagnoses an additional health problem during the course of the visit, covered services provided during the course of the visit to treat the additional health problem will also be covered. Covered, Medically Necessary laboratory services, imaging services, diagnostic services or prescription drugs or supplies (to the extent they are covered under this Certificate) ordered by the Participating Women’s Health Care Specialist will also be covered without prior Referral from the Member’s PCP. Certain Covered Benefits require preauthorization by HMO whether provided by the Member’s PCP or Women’s Health Care Specialist. See the Infertility Services section of this Certificate for a description of covered Infertility services.
Sample 1
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Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. • Mammography (for benefit details, please see the Preventive Health Care Services and Diagnostic Services Benefits provisions under the Covered Benefit section). • Coverage is provided for non-routine eye examination, diagnosis and treatment of conditions and diseases of the eye and related eye structures. A Referral from the Member's PCP is required for inpatient Hospital or surgical services.
Sample 1
Direct Access Specialist Benefits. The following services are covered without a Referral when rendered by a Participating Provider. • Direct Access to Gynecologists. Benefits are provided to female Members for services performed by a Participating gynecologist for diagnosis and treatment of gynecological problems. Direct access includes care related to pregnancy; care for all active gynecological conditions; and diagnosis, treatment and Referral for any disease or condition which is within the scope of the professional OB/GYN practice.
Sample 1

Related to Direct Access Specialist Benefits

  • Management of Special and Technical Environment Each certificated support person demonstrates an acceptable level of performance in managing and organizing the special materials, equipment and environment essential to the specialized programs.

  • Commercial Operation Date Testing and Modifications Prior to the Commercial Operation Date, the Connecting Transmission Owner shall test the Connecting Transmission Owner’s Attachment Facilities and System Upgrade Facilities and System Deliverability Upgrades and Developer shall test the Large Generating Facility and the Developer Attachment Facilities to ensure their safe and reliable operation. Similar testing may be required after initial operation. Developer and Connecting Transmission Owner shall each make any modifications to its facilities that are found to be necessary as a result of such testing. Developer shall bear the cost of all such testing and modifications. Developer shall generate test energy at the Large Generating Facility only if it has arranged for the injection of such test energy in accordance with NYISO procedures.

  • Post-Commercial Operation Date Testing and Modifications Each Party shall at its own expense perform routine inspection and testing of its facilities and equipment in accordance with Good Utility Practice as may be necessary to ensure the continued interconnection of the Large Generating Facility with the Participating TO’s Transmission System in a safe and reliable manner. Each Party shall have the right, upon advance written notice, to require reasonable additional testing of the other Party’s facilities, at the requesting Party’s expense, as may be in accordance with Good Utility Practice.

  • Operation and Maintenance Manuals Receipts for transmittal of Operation and Maintenance Manuals, Brochures and Data to the Design Professional (or Commissioning Agent) as required by Section 6.1.1.5.

  • Drug-Free Workplace Certification As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of Indiana, the Company hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free workplace at the Project Location. The Company will give written notice to the IEDC within ten (10) days after receiving actual notice that the Company, or an employee of the Company in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace. False certification or violation of this certification may result in sanctions including, but not limited to, suspension of payments under the Agreement, termination of the Agreement and/or debarment of contracting opportunities with the State for up to three (3) years. In addition to the provisions of the above paragraph, if the total amount set forth in the Agreement is in excess of $25,000.00, the Company agrees that it will provide a drug-free workplace by: A. Publishing and providing to all of its employees a statement notifying them that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Company’s workplace, and specifying the actions that will be taken against employees for violations of such prohibition;

  • Payments for Distribution Assistance and Administrative Support Services (a) Payments to the Distributor. In consideration of the payments made by the Fund to the Distributor under this Plan, the Distributor shall provide administrative support services and distribution services to the Fund. Such services include distribution assistance and administrative support services rendered in connection with Shares (1) sold in purchase transactions, (2) issued in exchange for shares of another investment company for which the Distributor serves as distributor or sub-distributor, or (3) issued pursuant to a plan of reorganization to which the Fund is a party. If the Board believes that the Distributor may not be rendering appropriate distribution assistance or administrative support services in connection with the sale of Shares, then the Distributor, at the request of the Board, shall provide the Board with a written report or other information to verify that the Distributor is providing appropriate services in this regard. For such services, the Fund will make the following payments to the Distributor:

  • Data Protection Impact Assessment If, pursuant to Data Protection Law, Customer (or its Controllers) are required to perform a data protection impact assessment or prior consultation with a regulator, at Customer’s request, SAP will provide such documents as are generally available for the Cloud Service (for example, this DPA, the Agreement, audit reports or certifications). Any additional assistance shall be mutually agreed between the Parties.

  • Evaluation, Testing, and Monitoring 1. The System Agency may review, test, evaluate and monitor Grantee’s Products and services, as well as associated documentation and technical support for compliance with the Accessibility Standards. Review, testing, evaluation and monitoring may be conducted before and after the award of a contract. Testing and monitoring may include user acceptance testing. Neither the review, testing (including acceptance testing), evaluation or monitoring of any Product or service, nor the absence of review, testing, evaluation or monitoring, will result in a waiver of the State’s right to contest the Grantee’s assertion of compliance with the Accessibility Standards. 2. Grantee agrees to cooperate fully and provide the System Agency and its representatives timely access to Products, records, and other items and information needed to conduct such review, evaluation, testing, and monitoring.

  • Technical Cooperation In order to facilitate the implementation of this Agreement, developed country Members shall provide, on request and on mutually agreed terms and conditions, technical and financial cooperation in favour of developing and least-developed country Members. Such cooperation shall include assistance in the preparation of laws and regulations on the protection and enforcement of intellectual property rights as well as on the prevention of their abuse, and shall include support regarding the establishment or reinforcement of domestic offices and agencies relevant to these matters, including the training of personnel.

  • Coordination, Oversight and Monitoring of Service Providers As set forth in the Administrative Services Agreement between the Fund and CRMC, CRMC shall coordinate, monitor and oversee the activities performed by the Service Providers with which AFS contracts. AFS shall monitor Service Providers’ provision of services including the delivery of Customer account statements and all Fund-related material, including summary prospectuses and/or prospectuses, shareholder reports, and proxies.

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