We use cookies on our site to analyze traffic, enhance your experience, and provide you with tailored content.

For more information visit our privacy policy.

Plan Service Area Sample Clauses

Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or reside within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. Please see the Plan Service Area chart at the back of this booklet for additional information on the geographic area served by this Plan. For specific information on the boundaries of the Plan Service Area members may also call Customer Service at the telephone number listed on the back page of this Evidence of Coverage
Sample 1Sample 2See All (4)
Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or work within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. For specific information on the boundaries of the Plan Service Area members may call Customer Service at the number provided on the back page of this EOC. (Special arrangements may be available for Dependents who are full-time students or do not live in the Subscriber’s home. Please contact the Member Services Department to request an Away From Home Care Program Brochure which explains these arrangements). In accordance with Blue Shield’s established poli- cies, and by statute, every contract between Blue Shield and its Plan Providers stipulates that the Sub- xxxxxxx shall not be responsible to the Plan Provider for compensation for any services to the extent that Whenever payment on a claim has been made in error, Blue Shield will have the right to recover such payment from the Subscriber or Member or, if applicable, the provider or another health benefit plan, in accordance with applicable laws and regulations. Blue Shield reserves the right to deduct or offset any amounts paid in error from any pending or future claim to the extent permitted by law. Circumstances that might result in payment of a claim in error include, but are not limited to, payment of benefits in excess of the benefits provided by the health plan, payment of amounts that are the responsibility of the Subscriber or Member (deductibles, copayments, coinsurance or similar charges), payment of amounts that are the responsibility of another payor, payments made after termination of the Subscriber or Member’s eligibility, or payments on fraudulent claims. There is no maximum limit on the aggregate pay- ments made by Blue Shield for Covered Services provided under this Group Health Service Contract. This Plan contains no annual dollar limits on essen- tial benefits as defined by federal law. they are provided in the Member’s group contract. Plan Providers have agreed to accept the Blue Shield’s payment as payment-in-full for Covered Services, except for Deductibles, Copayments and Coinsurance, and amounts in excess of specified Benefit maximums, or as provided under the Excep- tion for Other Coverage provision and the Reduc- tions section regarding Third Party Liability. If services are provided by a non-Plan provider, the Member is responsible for all amounts Blue Sh...
Sample 1
Plan Service Area the geographic area consisting of the following counties in western Pennsylvania: Allegheny Centre (Part) Forest Xxxxxx Xxxxxxxxx Clarion Xxxxxx Xxxxxx Xxxxxx Clearfield Huntingdon Somerset Bedford Xxxxxxxx Indiana Venango Xxxxx Elk Xxxxxxxxx Xxxxxx Xxxxxx Erie Xxxxxxxx Xxxxxxxxxx Cambria Xxxxxxx XxXxxx Xxxxxxxxxxxx Xxxxxxx 112. PRECERTIFICATION (CERTIFICATION) - a process whereby the Medical Necessity and Appropriateness of Inpatient admissions, Services or place of Services is determined by the Plan prior to, or after, an admission or the performance of a procedure or Service.
Sample 1
Plan Service Area. The geographic area served by this Plan is defined as the Plan Service Area. Subscribers and Dependents must live or work within the prescribed Plan Service Area to enroll in this Plan and to maintain eligibility in this Plan. For specific information on the boundaries of the Plan Service Area members may call Customer Service at the number provided on the back page of this EOC. (Special arrangements may be available for Dependents who are full-time students or do not live in the Subscriber’s home. Please contact the Member Services Department to request an Away From Home Care Program Brochure which explains these arrangements). In accordance with Blue Shield’s established poli- cies, and by statute, every contract between Blue Shield and its Plan Providers stipulates that the Sub- xxxxxxx shall not be responsible to the Plan Provider for compensation for any services to the extent that they are provided in the Member’s group contract. Plan Providers have agreed to accept the Blue Shield’s payment as payment-in-full for Covered Services, except for Deductibles, Copayments and Coinsurance, and amounts in excess of specified Benefit maximums, or as provided under the Excep- tion for Other Coverage provision and the Reduc- tions section regarding Third Party Liability. If services are provided by a non-Plan provider, the Member is responsible for all amounts Blue Shield does not pay. When a Benefit specifies a Benefit maximum and that Benefit maximum has been reached, the Mem- ber is responsible for any charges above the Benefit maximums.
Sample 1
Plan Service Area. For retirees who are eligible for Employer-paid Retiree Health Plan and who move to another Xxxxxx Permanente Region, the retiree will be required to participate in the out-of- region plan. The retiree, spouse or domestic partner, will be required to assign Medicare, when applicable. For retirees who are eligible for Employer-paid Retiree Health Plan and who move to an area not served by Xxxxxx Permanente, an out-of-area plan is available. The retiree also has the option of maintaining their Southern California Xxxxxx Permanente Retiree Health Plan. 2118 Retirees who reestablish residence within the service area will be returned to Kaiser Health Plan Coverage, within sixty (60) days of written notification of return to the Southern California Health Plan service area. Premiums for the alternative health plan will not exceed the premiums for Kaiser Health Plan Coverage.
Sample 1

Related to Plan Service Area

  • Service Area (a) SORACOM shall provide the SORACOM Air Global Service within the area designated on the web site of SORACOM (the “Service Area”), provided, that, the Service Area may be different if stated otherwise as specified by SORACOM separately. However, within the Service Area, you may not use the SORACOM Air Global Service in places where transmissions are difficult to send or receive. (b) The parties of this Agreement acknowledge that there may be countries or locations within which SORACOM may be restricted from providing the SORACOM Air Global Service due to applicable laws, regulations, decisions, rules or orders (“Restrictions”). During the Term, SORACOM will use reasonable efforts to monitor whether there are any such Restrictions. SORACOM may in its sole discretion and at any time, suspend, discontinue, limit, or modify the SORACOM Air Global Service or impose additional requirements on the provision of the SORACOM Air Global Service, as may be reasonably required to comply with any such Restrictions. (c) In no event will SORACOM be required to provide the SORACOM Air Global Service in countries or locations, or in a manner that would be in violation of the Restrictions and its failure to provide the SORACOM Air Global Service due to the Restrictions will not be deemed to be a breach of its obligations under this Agreement. (d) In the event that any Restriction, or any change in applicable law, regulation, decision, rule or order materially or adversely affects the delivery of the SORACOM Air Global Service (including the economic viability thereof), SORACOM will notify Subscribers in writing and the parties will negotiate in good faith regarding changes to this Agreement. If the parties cannot reach agreement within 30 days after notification from SORACOM requesting renegotiation, SORACOM may terminate the Agreement upon 30 days’ written notice to the Subscriber.

  • Service Areas HHSC authorizes the MA Dual SNP to add the MA Product to Texas service areas that are not identified in Attachment C, Proposed MA Product Service Areas, provided it receives prior CMS approval and complies with the notice requirements specified in this Agreement.

  • Interconnection Customer Compensation If the CAISO requests or directs the Interconnection Customer to provide a service pursuant to Articles 9.6.3 (Payment for Reactive Power) or 13.5.1 of this LGIA, the CAISO shall compensate the Interconnection Customer in accordance with the CAISO Tariff.

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Infertility Services Freezing, storage and thawing of embryos, sperm, or other tissues, for future use, unless the freezing, storage and thawing is needed due to potential iatrogenic infertility as described in Infertility Services in Section 3. • Reversal of voluntary sterilization or infertility treatment for a person that previously had a voluntary sterilization procedure. • Fees associated with finding an egg or sperm donor, related storage, donor stipend, or shipping charges. • Services related to surrogate parenting, when the surrogate is not a member of this

  • Mastectomy Services Inpatient

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Shared Services CUPE agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis recognizing the value of benefits to the members.

  • COMMERCIAL REUSE OF SERVICES The member or user herein agrees not to replicate, duplicate, copy, trade, sell, resell nor exploit for any commercial reason any part, use of, or access to 's sites.

  • Staffing Plan The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

Most Referenced Clauses

Most Referenced Definitions