Provison of Covered Services
Provison of Covered Services Sample Clauses
Related to Provison of Covered Services
Provision of Covered Services Contractor shall require each Participating Provider to ensure that each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by Covered California and Contractor, and which may include the following: i. Coordination with Covered California and other programs and stakeholders (Section 3.1); ii. Relationship of the parties as independent contractors (Section 1.3(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.3(b)); iii. Participating Provider Directory requirements (Section 4.4.4);
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.
Duration of Coverage Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by Xxxxxxxxxx, his/her agents, representatives, employees, or subconsultants.
Termination of Coverage This Contract may be terminated as follows:
Effective Date of Coverage An eligible employee is entitled to benefits provided he is actively at work on the first day the Long Term Disability Benefit Plan becomes effective. An eligible employee absent from work due to sickness or accident at the effective date of the Plan, shall only be eligible for Long Term Disability Plan benefits upon the return to continuous active full-time employment for a period of more than four consecutive weeks. The Company shall have the right to give medical examinations to employees returning from such lay-off to determine their eligibility under the Plan.
Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following: 1. All non-medically necessary services; 2. Sterilization of a mentally incompetent or institutionalized individual; 3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition; 4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility4 and for the reversal of sterilization;
Certification of Coverage Engineer shall furnish County with a certification of coverage issued by the insurer. Engineer shall not cause any insurance to be canceled nor permit any insurance to lapse. In addition to any other notification requires set forth hereunder, Engineer shall also notify County, within twenty-four (24) hours of receipt, of any notices of expiration, cancellation, non-renewal, or material change in coverage it receives from its insurer.
Continuation of Coverage If your coverage is terminated, you may be eligible to continue your coverage in accordance with state or federal law. In accordance with R.I. General Laws §. 27-19.1, if your employment is terminated due to one of the following reason, your healthcare coverage may be continued, provided that you continue to pay the applicable premiums. • Involuntary layoff or death; • The workplace ceasing to exist; or • Permanent reduction in size of the workforce. The period of this continuation will be for up to eighteen (18) months from your termination date, but not to exceed the period of continuous employment preceding termination with your employer. The continuation period will end for any person covered under your policy on the date the person becomes employed by another group and is eligible for benefits under that group’s plan.
Geographic Area and Sector Specific Allowances, Conditions and Exceptions The following allowances and conditions shall apply where relevant. Where the Employer does work which falls under the following headings, the Employer agrees to pay and observe the relevant respective conditions and/or exceptions set out below in each case.
Commencement of Coverage Coverage under the provisions of this article shall apply to regular full-time and regular part-time employees who work 15 regular hours or more per week and shall commence on the first day of the calendar month immediately following the completion of the employee's probationary period.
