How Non-Network Providers Are Sample Clauses

How Non-Network Providers Are. Paid You are responsible for paying all charges from a non-network provider. You are liable for the difference between the amount that the non-network health care provider bills and the payment made for covered health care services. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk-sharing, care coordination, value-based or similar programs. Generally, we send reimbursement to you; but, we reserve the right to reimburse a non-network provider directly. We reimburse you or a non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles which may apply to a covered health care service. We reimburse non-network provider services using the same guidelines used to pay network providers. If an allowance for a specific covered health care service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. Generally, our payment for non-network provider services will not be more than the amount that is paid for network provider services. Payments made to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization.
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How Non-Network Providers Are. Paid You are responsible for paying all charges from a non-network provider. You are liable for the difference between the amount that the non-network health care provider bills and the payment made for covered health care services. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk-sharing, care coordination, value-based or similar programs. Generally, this agreement sends reimbursement to you; but, this agreement reserves the right to reimburse a non-network provider directly. This agreement reimburses you or a non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles which may apply to a covered health care service. This agreement reimburses non-network provider services using the same guidelines used to pay network providers. . If an allowance for a specific covered health care service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. Generally, our payment for non-network provider services will not be more than the amount that is paid for network provider services. Payments made to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the Rhode Island General Law §27-20-49 (Dental Insurance assignment of benefits) applies.
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How Non-Network Providers Are. Paid Services received from a non-network provider are NOT COVERED except in the following limited circumstances: • Emergency care (Emergency Room Services and Ambulance Services); • We specifically approve the use of a non-network provider for covered health care services; • Covered health care services are rendered by a non-network provider at a network facility outside of your control as described in Section 4.1; • Hearing aids, in accordance with Rhode Island General Law § 27-20-46; • Hair prosthetics (wigs), in accordance with Rhode Island General Law §27-20-53; or • Enteral formula or food taken orally, in accordance with Rhode Island General Law §27-20- 56. If you receive care from a non-network provider, you are responsible for paying all charges from a non-network provider. You are liable for the difference between the amount that the non-network health care provider bills and the payment we make for covered health care services. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk-sharing, care coordination, value-based or similar programs. Generally, we send reimbursement to you; but, we do reserve the right to reimburse a non-network provider directly. We reimburse you or a non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service. We reimburse non-network provider services using the same guidelines we use to pay network providers. If an allowance for a specific covered health care service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the Rhode Island General Law §27-20-49 (Dental Insurance assignment of benefits) applies.
Sample 1
How Non-Network Providers Are. Paid You are responsible for paying all charges from a non-network provider. We reimburse you up to the maximum benefit or our allowance, less any copayments and/or deductibles which may apply to a covered health care service or procedure. We reimburse you for non-network provider services according to the same guidelines we use to pay network providers. Our reimbursement for non-network provider services will never be more than the amount we pay for network provider services. Benefits may not be assigned, unless the Rhode Island General Law §27-20-49 (Dental Insurance assignment of benefits) applies.
Sample 1
How Non-Network Providers Are. Paid You are responsible for paying all charges from a non-network provider. You are liable for the difference between the amount that the non-network health care provider bills and the payment we make for covered health care services. Generally, we send reimbursement to you; but, we do reserve the right to reimburse a non-network provider directly. We reimburse you or a non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles which may apply to a covered health care service. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the Rhode Island General Law §27-20-49 (Dental Insurance assignment of benefits) applies.
Sample 1

Related to How Non-Network Providers Are

  • How Non-network Providers Are Paid If you receive care from a non-network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. For the limited circumstances listed below, your copayment and deductible will apply at the network level of benefits: • emergency care (emergency room, urgent care and ambulance services); • we specifically approve the use of a non-network provider for covered healthcare services, see Network Authorization in Section 5 for details; • covered healthcare services are rendered by a non-network provider at a network facility outside of your control; • otherwise, as required by law. For those circumstances where we cover services from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, up to the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are liable for the difference between the amount that the non-network provider bills and the payment we make for covered healthcare services. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. For emergency services, we reimburse non- network providers, in accordance with R.I. Gen. Laws § 27-18-76, the greater of our allowance, our usual guidelines for paying non-network providers, or the amount that would be paid under Medicare, less any copayments or deductibles. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies. For information about network authorization requests to seek covered healthcare services from a non-network provider when the covered healthcare service cannot be provided by a network provider, please see Network Authorization in Section 5.

  • NON-NETWORK PROVIDER is a provider that has not entered into a contract with us or any other Blue Cross and Blue Shield plan. For pediatric dental care services, non-network provider is a dentist that has not entered into a contract with us or does not participate in the Dental Coast to Coast Network. For pediatric vision hardware services, a non-network provider is a provider that has not entered into a contract with EyeMed, our vision care service manager.

  • INDEPENDENT PERSONAL SERVICES 1. Income derived by a resident of a Contracting State in respect of professional services or other activities of an independent character shall be taxable only in that State except in the following circumstances, when such income may also be taxed in the other Contracting State:

  • NON-TEACHING DUTIES A. The Committee and the Association agree that a teacher's primary responsibility is to teach. It must be remembered, however, that in addition to that primary purpose there are other responsibilities within the School that must be assumed by teachers. The Committee and the Association recognize that paraeducators, clerical employees are useful and necessary in order to implement teaching. The Committee, having made provisions for paraeducators, will continue to work toward the improvement of this situation.

  • SERVICE PROVIDER’S PERSONNEL 10.1 The Service Provider’s Personnel shall be regarded at all times as employees, agents or Subcontractors of the Service Provider and no relationship of employer and employee shall arise between Transnet and any Service Provider Personnel under any circumstances regardless of the degree of supervision that may be exercised over the Personnel by Transnet.

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18 and 19, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State.

  • Visitors to and Conduct on School Property Petitions or written correspondence to the Board shall be presented to the Board in the next regular Board packet. LEGAL REF.: 5 ILCS 120/2.06, Open Meetings Act. 105 ILCS 5/10-6 and 5/10-16. CROSS REF.: 2:220 (School Board Meeting Procedure), 8:10 (Connection with the Community), 8:30 (Visitors to and Conduct on School Property) Adopted: September 5, 2019 Meridian CUSD 223 2:240 Board Policy Development The School Board governs using written policies. Written policies ensure legal compliance, establish Board processes, articulate District ends, delegate authority, and define operating limits. Board policies also provide the basis for monitoring progress toward District ends. Policy Development Anyone may propose new policies, changes to existing policies, or elimination of existing policies. Staff suggestions should be processed through the Superintendent. Suggestions from all others should be made to the Board President or the Superintendent. A Board Policy Committee will consider all policy suggestions, and provide information and recommendations to the Board. The Superintendent is responsible for: (1) providing relevant policy information and data to the Board,

  • EMPLOYEE DATA So long as not prohibited by law and to the extent possible, the System President shall furnish to MSEA quarterly, at Union expense, a listing of the then-available information, specified hereinafter, for each employee covered by this Agreement. The listing shall contain, to the extent practicable, the name, address, Social Security number, class code, classification, pay range and step, MCC/System Office and initial date of hire for each employee covered by this Agreement. MSEA shall indemnify, defend and hold the Trustees harmless against all claims and suits which may arise as a result of the MCC System's furnishing such listing to MSEA.

  • Restricted Use By Outsourcers / Facilities Management, Service Bureaus or Other Third Parties Outsourcers, facilities management or service bureaus retained by Licensee shall have the right to use the Product to maintain Licensee’s business operations, including data processing, for the time period that they are engaged in such activities, provided that: 1) Licensee gives notice to Contractor of such party, site of intended use of the Product, and means of access; and 2) such party has executed, or agrees to execute, the Product manufacturer’s standard nondisclosure or restricted use agreement which executed agreement shall be accepted by the Contractor (“Non-Disclosure Agreement”); and 3) if such party is engaged in the business of facility management, outsourcing, service bureau or other services, such third party will maintain a logical or physical partition within its computer system so as to restrict use and access to the program to that portion solely dedicated to beneficial use for Licensee. In no event shall Licensee assume any liability for third party’s compliance with the terms of the Non-Disclosure Agreement, nor shall the Non-Disclosure Agreement create or impose any liabilities on the State or Licensee. Any third party with whom a Licensee has a relationship for a state function or business operation, shall have the temporary right to use Product (e.g., JAVA Applets), provided that such use shall be limited to the time period during which the third party is using the Product for the function or business activity.

  • Replacement of Key Personnel The Engineer must notify the State in writing as soon as possible, but no later than three business days after a project manager or other key personnel is removed from association with this contract, giving the reason for removal.

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