ENROLLMENT PROTECTION Sample Clauses
The Enrollment Protection clause is designed to safeguard the interests of parties involved in an enrollment process, typically in educational or service-based agreements. It may outline conditions under which a participant’s enrollment is secured, such as payment of fees, submission of required documents, or adherence to deadlines, and can specify remedies or accommodations if unforeseen circumstances prevent participation. This clause primarily functions to provide assurance and clarity regarding the status and security of enrollment, reducing uncertainty and protecting both the enrolling party and the provider from potential disputes or losses.
ENROLLMENT PROTECTION. 8.01 Enrollment Protection is a program designed to limit PARTICIPATING MEDICAL GROUP’s liability for Capitation Services expense.
8.02 For PARTICIPATING MEDICAL GROUPs with less than *** Members, on the effective date of this Agreement, the liability of PARTICIPATING MEDICAL GROUP for expenses for Capitation Services rendered to any single Member during the calendar year shall be limited to the first *** of such expenses.
8.03 If PARTICIPATING MEDICAL GROUP’s assigned CALIFORNIACARE and BLUE CROSS PLUS enrollment is *** or more Members, on the effective date of this Agreement, PARTICIPATING MEDICAL GROUP agrees to accept risk under either Subsection A or Subsection B, as indicated below.
A. The liability of PARTICIPATING MEDICAL GROUP for expenses for Capitation Services rendered to any single Member during the calendar year, shall be limited to the first *** of Capitation Services expenses, which have been incurred by PARTICIPATING MEDICAL GROUP for that Member, or
B. The liability of PARTICIPATING MEDICAL GROUP for expenses for Capitation Services rendered to any single Member during the calendar year, shall be limited to the first *** of Capitation Services expenses which have been incurred by PARTICIPATING MEDICAL GROUP for that Member. PARTICIPATING MEDICAL GROUP hereby elects to accept risk pursuant to Section 8.03. o A. o B. (Check one).
8.04 Notwithstanding Section 8.02 or 8.03 above, the liability of PARTICIPATING MEDICAL GROUP for expenses for Capitation Services for Members who have been diagnosed as having Acquired Immune Deficiency Syndrome (AIDS) shall be limited to FIFTEEN HUNDRED DOLLARS ($1,500.00) for any Member who has been diagnosed as having AIDS according to the most current criteria established by the Center for Disease Control (CDC) at the time of the diagnosis.
8.05 The total expenses of PARTICIPATING MEDICAL GROUP for Capitation Services rendered to any single Member during the calendar year shall be calculated according to the fee schedule set forth in Exhibit E. In the event the foregoing calculation for any given procedure results in a figure greater than the actual cost of the procedure as billed by a third party, then the actual cost for that procedure Shall be deemed to be the amount actually paid by PARTICIPATING MEDICAL GROUP.
8.06 Expenses in connection with the following services shall not be included as Capitation Services expenses incurred by PARTICIPATING MEDICAL GROUP in reaching the Enrollment Protection level:
A. ...
ENROLLMENT PROTECTION. Section 8.06.1 is hereby added to read: Expenses in connection with the following services shall not be included as AIM Capitation Services expenses incurred by PARTICIPATING MEDICAL GROUP in reaching the AIM Enrollment Protection level:
ENROLLMENT PROTECTION. Section 8.07.1 is hereby added to read: PARTICIPATING MEDICAL GROUP shall maintain records necessary to evidence having reached the AIM Enrollment Protection level. After reaching the AIM Enrollment Protection level with regard to any AIM Program Member, during the remainder of a mother’s enrollment or the remainder of the calendar year of an infant’s enrollment, PARTICIPATING MEDICAL GROUP shall ▇▇▇▇ BLUE CROSS for one hundred percent (100%) of services rendered, or provided, to that Member by PARTICIPATING MEDICAL GROUP, calculated in accordance with Sections 8.03.1, 8.05.1, and 8.06.1. Reimbursement to PARTICIPATING MEDICAL GROUP shall be made by BLUE CROSS in accordance with the fee schedule set forth in Exhibit E, on a monthly basis, within forty-five (45) working days of submission of complete and accurate documentation by PARTICIPATING MEDICAL GROUP. Services which are not set forth in Exhibit E shall be reimbursed by BLUE CROSS at the actual charges paid by PARTICIPATING MEDICAL GROUP.
ENROLLMENT PROTECTION. Section 8.05.1 is hereby added to read: The total expenses of PARTICIPATING MEDICAL GROUP for AIM Capitation Services rendered to any single Member during the mother’s enrollment and each calendar year of the infant’s enrollment shall be calculated according to the fee schedule set forth in Exhibit E. In the event the foregoing calculation for any given procedure results in a figure greater than the actual cost of the procedure as billed by a third party then the actual cost for that procedure shall be deemed to be the amount actually paid by PARTICIPATING MEDICAL GROUP.
ENROLLMENT PROTECTION. Section 8.03.1 is hereby added to read: The liability of PARTICIPATING MEDICAL GROUP for expenses for AIM Capitation Services rendered to any single Member enrolled in BLUE CROSS’ AIM Program shall be limited to the first Six Thousand Dollars ($6,000.00) of such expenses during the mother’s enrollment and each calendar year of the infant’s enrollment if PARTICIPATING MEDICAL GROUP elects Enrollment. Protection as set forth in Exhibit K-1 herein.