Expedited Review. In disciplinary matters, dismissal and termination actions may be expedited to arbitration by either the Union or the Employer.
Expedited Review. If you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or if you are undergoing a current course of treatment using a non-formulary drug, you can request an expedited review. We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 24 hours following receipt of your request. If our initial determination is overturned, we will provide coverage for the PrEP medication or PrEP related service that is medically appropriate for you for the duration of the treatment. For more information or assistance with your complaint, grievance or an exception request, you may contact the Managed Health Care Bureau (MHCB) of the Office of Superintendent of Insurance at: P.O. Box 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 E-mail: xxxx.xxxxxxxxx@xxxxx.xx.xx This endorsement is retroactive back to the effective date of your coverage with us, or January 1, 2022, whichever comes first. These items replace and supersede any conflicting provision of your insurance contract and summary of benefits and coverage. All other requirements of the policy not in conflict with this endorsement still apply. Welcome 13 Welcome to Presbyterian Health Plan! 13 Our Agreement with You 13 Understanding This Agreement 14 Customer Assistance 15 Member Rights and Responsibilities 17 This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. Member Rights 17 Additional Member Rights and Responsibilities 18 Consumer Advisory Board 20 How the Plan Works 21 This section explains how to find Practitioners/Providers who are in our Network (In- network), get Healthcare Services both In-network and Out-of-network, requirements you must follow when getting care and how to receive Covered Benefits under this Agreement. Provider Directory 22 Obtaining Healthcare 22 How to Obtain a PCP 22 Women’s Healthcare Provider/Practitioner 23 Specialist Care 23 Obtaining Care after Normal Provider Office Hours 24 In-Network Practitioners/Providers 24 Out-of-Network Practitioners/Providers 25 Out-Of-Network Care And Bills 26 Restrictions on Services Received Outside of the PHP Service Xxxx 00 National PPO Providers 28 Restrictions on Services Received Outside of the PHP Service Area 28 National Health Care Practitioner/Provider Network 29 Cost Sharing – Your Out-of-Pocket Costs 29 Annual Contrac...
Expedited Review. If you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or if you are undergoing a current course of treatment using a non-formulary drug, you can request an expedited review. We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 24 hours following receipt of your request. If our initial determination is overturned, we will provide coverage for the PrEP medication or PrEP related service that is medically appropriate for you for the duration of the treatment. For more information or assistance with your complaint, grievance or an exception request, you may contact the Managed Health Care Bureau (MHCB) of the Office of Superintendent of Insurance at: P.O. Box 1689 Santa Fe, NM 87504-1689 Routine Immunization includes Coverage for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of: The Advisory Committee on Immunization Practices Centers for Disease Control and Prevention. The U.S. Preventive Services Task Force (USPSTF) o HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).
Expedited Review. In the event a Disputed Matter concerns any matter that has material economic, risk or compliance implications to Bank, Retailer or the Program, including the Cardholder Terms or the risk management policies (a “Material Issue”), either Bank or Retailer may request an expedited review of such Material Issue (an “Expedited Review”). Expedited Review shall consist of the following procedures:
(a) A notice to request Expedited Review (an “Expedited Review Notice”) shall be provided by either party to the other party.
(b) The Senior Officers shall meet in person or by telephone within five (5) Business Days after the receipt of the Expedited Review Notice and will attempt in good faith to resolve any Material Issue. In the event the Senior Officers do not resolve any Material Issue within five (5) Business Days after the receipt of the Expedited Review Notice, if such Disputed Matter is a Retailer Matter, it will be decided within the sole discretion of Retailer, and if such Disputed Matter is a Bank Matter, it will be decided within the sole discretion of Bank.
Expedited Review. In disciplinary matters, the Union and the Employer may agree to expedite the grievance directly to arbitration.
Expedited Review o If you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or if you are undergoing a current course of treatment using a non-formulary drug, you can request an expedited review. We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 24 hours following receipt of your request. If our initial determination is overturned, we will provide coverage for the PrEP medication or PrEP related service that is medically appropriate for you for the duration of the treatment. For more information or assistance with your complaint, grievance or an exception request, you may contact the Managed Health Care Bureau (MHCB) of the Office of Superintendent of Insurance at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance - MHCB P.O. Box 1689, Santa Fe, NM 00000-0000 Fax: (000) 000-0000, Attn: MHCB Routine Immunization includes Coverage for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of: • The American Academy of Pediatrics • The Advisory Committee on Immunization Practices Centers for Disease Control and Prevention. • The U.S. Preventive Services Task Force (USPSTF) o Immunizations for routine use in children, adolescents, and adults that have, in effect, a recommendation from the Advisory Committee on Immunizations Practices of the Centers for Disease Control and Prevention (Advisory Committee) with respect to the individual involved. o HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP).
Expedited Review. Under the circumstances below, City shall cooperate to expedite the development design review process, building plan review process, improvement plan review process, and the entitlement review process for the developments to be located on the Property. Review of any application through an expedited process as provided by this subparagraph shall not be deemed to waive any of the Applicable Rules pertaining to review or approval of such application, including, but not limited to, a public hearing, if any, required therefore. Should developer request review of any application through an expedited process, and should City agree, Developer authorizes the imposition of fees paid to the City beyond the permit/plan review fees allowed by Millbrae’s Municipal Code, in an amount sufficient to cover City’s estimated costs of utilizing additional City staff or retaining an outside consultant or any combination thereof in order to expedite the review process during the Term.
Expedited Review a. Subject to Section 8.02 above, the internal appeals process must allow for expedited review. If a Member requests an expedited review, the MCO must determine within one business day of receipt of the request, whether to expedite the review or whether to perform the review according to the standard timeframes.
b. An expedited review must be performed when the standard timeframes for determining an appeal could jeopardize the life or health of the Member or the Member's ability to regaining maximum functioning. The MCO must expedite its review in all cases in which such a review is requested by the Member's treating physician or primary care provider, functioning within his or her scope of practice as defined under state law, or by the DEPARTMENT.
Expedited Review. If you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or if you are undergoing a current course of treatment using a non-formulary drug, you can request an expedited review. We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 24 hours following receipt of your request. If our initial determination is overturned, we will provide coverage for the PrEP medication or PrEP related service that is medically appropriate for you for the duration of the treatment. For more information or assistance with your complaint, grievance or an exception request, you may contact the Managed Health Care Bureau (MHCB) of the Office of Superintendent of Insurance at: X.X. Xxx 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 Routine Immunization includes Coverage for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of: • The Advisory Committee on Immunization Practices Centers for Disease Control and Prevention. • The U.S. Preventive Services Task Force (USPSTF) • HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP). Childhood Preventive Health Services includes Coverage for Well-Child Care in accordance with the recommendations of the U.S. Preventive Services Task Force (USPSTF). We will provide Coverage for Clinical Preventive Health Services without any Cost Sharing at an age and frequency as determined by your In-network Practitioner/Provider. You can review the recommended clinical preventive health services at xxxxx://xxx.xxx.xxx/tools-resources/patient/Pages/preventive-care-guidelines.aspx. With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes: • Anxiety in Children and Adolescents: Screening • Health appraisal exams, laboratory and radiological tests, and early detection procedures for the purpose of a routine physical exam or as required for participation in sports, school, or camp activities. • Hearing and Vision screening for correction. This does not include routine eye...
Expedited Review. In the event a Party requests Expedited Review of a Disputed Matter, such changes relating to such Disputed Matter shall not be implemented by a Party until the completion of the review process set forth in this Section 4.9 (“Expedited Review”) and the Parties have approved such changes; provided, however, that a Party may immediately implement any change required by Applicable Law or as necessary to prevent fraud after sending notice to the other Parties describing the change and its rationale for such change. Disputed Matters subject to Expedited Review are subject to the following procedures:
(a) Upon a notice of a request for Expedited Review of a Disputed Matter, the Parties shall attempt to resolve the Disputed Matter promptly by negotiations between the Senior Officers or their respective designees. The Senior Officers or their designees will meet in person or by telephone within five Business Days after the notice of Expedited Review and attempt in good faith to resolve the Disputed Matter.
(b) In the event the Senior Officers do not resolve the Disputed Matter within five Business Days from receipt of the notice of Expedited Review, the Parties shall refer the Disputed Matter to the CEOs or their respective designees. The CEOs will meet in person or by telephone within five Business Days after the notice of Expedited Review and attempt in good faith to resolve the Disputed Matter. In the event the CEOs or their designees do not resolve the Disputed Matter within five Business Days from receipt of the referral notice from the Senior Officers, the Parties agree that all Disputed Matters that are Retailer Matters will be decided within the sole discretion of Retailer, and all Disputed Matters that are GDC Matters will be decided within the sole discretion of GDC and Bank. In the event the Disputed Matter is not a Retailer Matter or a GDC Matter, then this Agreement will control or if there is no governing provision in this Agreement, the matter will remain as status quo.
