Common use of Plan Hospitals Clause in Contracts

Plan Hospitals. Each PMG is affiliated with at least one Plan Hospital. Consequently, except for Emergency Services, each Member must receive Hospital Services from the Plan Hospital affiliated with the PMG selected by or for the Member. In the event Hospital Services are not available at such Plan Hospital, the Member will be referred to another Plan Hospital to receive such Hospital Services. If services for the medically necessary treatment of a mental health or substance use disorder are not available in network within the geographic and timely access standards set by law or regulation, the health care service plan shall arrange coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary follow-up services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this subdivision, to “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary out-of-network options that are available to the enrollee within geographic and timely access standards. The enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from an in-network provider.

Plan Hospitals. Each PMG is affiliated with at least one Plan Hospital. Consequently, except for Emergency Services, each Member must receive Hospital Services from the Plan Hospital affiliated with the PMG selected by or for the Member. In the event Hospital Services are not available at such Plan Hospital, the Member will be referred to another Plan Hospital to receive such Hospital Services. If services for the medically necessary treatment of a mental health or substance use disorder are not available in network within the geographic and timely access standards set by law or regulation, the health care service plan shall arrange coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary follow-up followup services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this subdivision, to “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary out-of-network options that are available to the enrollee within geographic and timely access standards. The enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from an in-network provider.