Limitation on Services. Except in cases of Emergency Services or Urgent Care, or as otherwise provided under this Certificate, services are available only from Participating Providers and HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 9 contracts
Samples: Certificate of Coverage, Group Agreement, Certificate of Coverage
Limitation on Services. Except in cases of Emergency Services or Urgent Carea Medical Emergency, or as otherwise provided under the Covered Benefits section of this Certificate, services are available only from Participating Providers and Providers. HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 3 contracts
Samples: Group Agreement, Certificate of Coverage, Group Agreement
Limitation on Services. Except in cases of Emergency Services or Urgent Care, or as otherwise provided under this CertificateEOC, services are available only from Participating Providers and HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Limitation on Services. Except in cases of an Emergency Services Medical Condition or Urgent Care, or as otherwise provided under the Covered Benefits section of this Certificate, services are available only from Participating Providers and Providers. HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Limitation on Services. Except in cases of Medical Emergency Services or Urgent Care, or as otherwise provided under in this Certificate, services are available only from Participating Providers and Providers. HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, non-participating Provider or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 1 contract
Samples: Group Agreement
Limitation on Services. Except in cases of a Medical Emergency Services or the need for Urgent Care, Care or as otherwise provided under this Certificate, services are available only from Participating Providers and HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 1 contract
Samples: Certificate of Coverage
Limitation on Services. Except in cases of Emergency Services or Urgent Care, or emergency as otherwise provided under Section II.G of this CertificateContract, services are available only from Participating Providers and Providers. HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, Home Health Agency or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 1 contract
Limitation on Services. Except in cases of Emergency Services Care or Urgent Care, or as otherwise provided under this Certificate, services are available only from Participating Providers and HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency,Home Health Care Agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 1 contract
Samples: Group Agreement
Limitation on Services. Except in cases of an Emergency Services or Service, Urgent Care, or and Emergency/Urgent follow-up care as otherwise provided under this Certificate, services are available only from Participating Providers and HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 1 contract
Samples: Group Agreement
Limitation on Services. Except as provided under N.J.S.A. 30:7E, or in cases of a Medical Emergency Services or and Urgent Care, or as otherwise provided under the Covered Benefits section of this Certificate, services are available only from Participating Providers and Providers. HMO shall have no liability or obligation whatsoever on account of any service or benefit sought or received by a Member from any Physician, Hospital, Skilled Nursing Facility, home health care agency, or other person, entity, institution or organization unless prior arrangements are made by HMO.
Appears in 1 contract
Samples: Group Agreement