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: • 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 5.1; • 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. For those limited circumstances listed above, see section 5.3 for how services are paid. If you receive care from a non-network provider, you are responsible for paying all charge 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.
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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 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 unless he has a fixed base regularly available to him in the other Contracting State for the purpose of performing his activities. If he has such a fixed base, the income may be taxed in the other State but only so much of it as is attributable to that fixed base. 2. The term "professional services" includes especially independent scientific, literary, artistic, educational or teaching activities as well as the independent activities of physicians, lawyers, engineers, architects, dentists and accountants.

  • NON-TEACHING DUTIES The Board and the Association acknowledge that a teacher's primary responsibility is to teach, and that his/her energies should be utilized to this end. It is agreed that teachers will be relieved of non-teaching duties to the extent possible and practical through the use of non-teaching personnel to perform clerical-type tasks and supervise playgrounds and lunchrooms.

  • 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. 10.2 The Service Provider warrants that all its Personnel will be entitled to work in South Africa or any other country in which the Services are to be performed. 10.3 The Service Provider will ensure that its Personnel comply with all reasonable requirements made known to the Service Provider by Transnet concerning conduct at any Transnet premises or any other premises upon which the Services are to be performed [including but not limited to security regulations, policy standards and codes of practice and health and safety requirements]. The Service Provider will ensure that such Personnel at all times act in a lawful and proper manner in accordance with these requirements. 10.4 Transnet reserves the right to refuse to admit or to remove from any premises occupied by or on behalf of it, any Service Provider Personnel whose admission or presence would, in the reasonable opinion of Transnet, be undesirable or who represents a threat to confidentiality or security or whose presence would be in breach of any rules and regulations governing Transnet's Personnel, provided that Transnet notifies the Service Provider of any such refusal [with reasons why]. The reasonable exclusion of any such individual from such premises shall not relieve the Service Provider from the performance of its obligations under this Agreement. 10.5 The Service Provider agrees to use all reasonable endeavours to ensure the continuity of its Personnel assigned to perform the Services. If any re-assignment by the Service Provider of those Personnel is necessary, or if Transnet advises that any such Personnel assigned are in any respect unsatisfactory, including where any such Personnel are, or are expected to be or have been absent for any period, then the Service Provider will promptly supply a replacement of equivalent calibre and experience, and any such replacement shall be approved by Transnet prior to commencing provision of the Services, such approval not to be unreasonably withheld or delayed.

  • 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. 2. Notwithstanding the provisions of paragraph 1, remuneration derived by a resident of a Contracting State in respect of an employment exercised in the other Contracting State shall be taxable only in the first-mentioned State if: a) the recipient is present in the other State for a period or periods not exceeding in the aggregate 183 days in any twelve-month period commencing or ending in the tax year concerned, and b) the remuneration is paid by, or on behalf of, an employer who is not a resident of the other State, and c) the remuneration is not borne by a permanent establishment or a fixed base which the employer has in the other State. 3. Notwithstanding the preceding provisions of this Article, remuneration derived in respect of an employment exercised aboard a ship or aircraft operated in international traffic by a resident of a Contracting State, may be taxed in that State.

  • The Web Services E-Verify Employer Agent agrees to, consistent with applicable laws, regulations, and policies, commit sufficient personnel and resources to meet the requirements of this MOU.

  • 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.

  • The Service Provider upon receipt of a notice contemplated under clause 19.1 shall discontinue the supply of all services or goods under this Agreement, to the extent specified, and on the date specified in the notice.

  • Review Systems; Personnel It will maintain business process management and/or other systems necessary to ensure that it can perform each Test and, on execution of this Agreement, will load each Test into these systems. The Asset Representations Reviewer will ensure that these systems allow for each Review Receivable and the related Review Materials to be individually tracked and stored as contemplated by this Agreement. The Asset Representations Reviewer will maintain adequate staff that is properly trained to conduct Reviews as required by this Agreement.

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