Common use of Expedited Review Clause in Contracts

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: Address: Office of Superintendent of Insurance Managed Health Care Bureau P.O. Box 1689 Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-000-0000 Fax: (000) 000-0000 Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Routine Immunizations 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. 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 Managed Health Care Bureau - MHCB P.O. Box 1689 1689, Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: File complaint: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Routine Immunizations 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).