Common use of Quality Assurance Programs Clause in Contracts

Quality Assurance Programs. The goal of our Quality Program is to ensure the provision of consistently excellent health care, health information and service to you, enabling you to maintain and improve your physical and behavioral health and well-being. Some components of the quality program are directed to all Covered Persons and others address specific medical issues and providers. Examples of quality activities in place for all Covered Person’s include a systematic review and re-review of the credentials of Network providers and contracted facilities, as well as the development and dissemination of clinical standards and guidelines in areas such as preventive care, medical records, appointment access, confidentiality, and the appropriate use of drug therapies and new medical technologies. Activities affecting specific medical issues and providers include disease management programs for those with chronic diseases like asthma, diabetes and congestive heart failure, and the investigation and resolution of quality-of-care complaints registered by individual Covered Persons. Your coverage in this health plan is not limited based on medical conditions that are present on or before your effective date. This means that your health care services will be covered from the effective date of your coverage in this health plan without a pre-existing condition restriction or a waiting period. But, benefits for these health care services are subject to all provisions of this health plan.

Quality Assurance Programs. The goal of the our Quality Program is to ensure the provision of consistently excellent health care, health information and service to you, enabling you to maintain and improve your physical and behavioral health and well-being. Some components of the quality program are directed to all Covered Persons and others address specific medical issues and providers. Examples of quality activities in place for all Covered Person’s include a systematic review and re-review of the credentials of Network providers and contracted facilities, as well as the development and dissemination of clinical standards and guidelines in areas such as preventive care, medical records, appointment access, confidentiality, and the appropriate use of drug therapies and new medical technologies. Activities affecting specific medical issues and providers include disease management programs for those with chronic diseases like asthma, diabetes and congestive heart failure, and the investigation and resolution of quality-of-care complaints registered by individual Covered Persons. Your coverage in this health plan is not limited based on medical conditions that are present on or before your effective date. This means that your health care services will be covered from the effective date of your coverage in this health plan without a pre-existing condition restriction or a waiting period. But, benefits for these health care services are subject to all provisions of this health plan.