Provision of Health Care Services and Benefits Sample Clauses

Provision of Health Care Services and Benefits. The Subscribing Group engages AvMed, on behalf of the group health plan described herein (the “Plan”), to arrange for the provision of Covered Benefits or Covered Services which are Medically Necessary for the diagnosis and treatment of Members of the Subscribing Group. AvMed arranges for the delivery of Covered Services in accordance with the covenants and conditions contained in this Contract, and does not directly provide these Covered Services. AvMed will rely upon the statements of the Subscriber in his application in arranging for the provision of Covered Services hereunder.
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Provision of Health Care Services and Benefits. During the term of this Contract, we agree to arrange for the provision of Covered Benefits or Covered Services which are Medically Necessary for the diagnosis and treatment of Members, subject to all applicable terms, conditions, Limitations and Exclusions set forth herein. AvMed arranges for the delivery of Covered Services in accordance with the covenants and conditions contained in this Contract, and does not directly provide these Covered Services.

Related to Provision of Health Care Services and Benefits

  • Health Care Benefits (a) Each regular full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:

  • Health Benefits The method for determining the Employer bi-weekly contributions to the cost of employee health insurance programs under the Federal Employees Health Benefits Program (FEHBP) will be as follows:

  • Urgent Care Services All Medically Necessary Covered Services received in Urgent Care Centers, Retail Clinics or your Primary Care Physician’s office after-hours to treat an Urgent Medical Condition will be covered by AvMed. Any request for reimbursement of payment made by a Member for services received must be filed within 90 days or as soon as reasonably possible but not later than one year unless the Member was legally incapacitated. If Urgent Medical Services and Care are required while outside the continental United States, Alaska or Hawaii, it is the Member’s responsibility to pay for such services at the time they are received. For information on filing a Claim for such services, see Part XIII. REVIEW PROCEDURES AND HOW TO APPEAL A CLAIM (BENEFIT) DENIAL.

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