Referred Services Sample Clauses

Referred Services. (1) A PHO or Contracted Provider may, in the course of an annual health check, refer an Eligible Person to the following Referred Services, if it is appropriate to do so:
Sample 1Sample 2Sample 3See All (10)
AutoNDA by SimpleDocs
Referred Services. Except as described in the Exclusions and Limitations section of this Rider, the Certificate, any amendments and/or riders are hereby revised to remove the requirement that a Member must obtain a Referral from their PCP prior to accessing Covered Benefits from Participating Providers. Under this provision, a Member may directly access Participating Specialists, ancillary Providers and facilities for Covered Benefits without a PCP Referral, subject to the terms and conditions of the Certificate and any cost-sharing requirements set forth in the Schedule of Benefits. Participating Providers will be responsible for obtaining pre-authorization of services from HMO. Except as described in this Rider, the Covered Benefits section and the Exclusions and Limitations section of the Certificate remain unchanged and the ability of a Member to directly access Participating Providers does not alter any other provisions of the Certificate. Except for Emergency Services and out- of-area Urgent Care services, a Member must access Covered Benefits from Participating Providers and facilities or benefits will not be covered under this Certificate and a Member will be responsible for all expenses incurred unless HMO has pre-authorized the services to a non-participating Provider. The Exclusions and Limitations section of the Certificate is amended to delete the following exclusion: • Unauthorized services, including any service obtained by or on behalf of a Member without a prior written Referral issued by the Member’s PCP or certified by HMO. This exclusion does not apply in a Medical Emergency or in an Urgent Care situation or when it is a direct access benefit. The Exclusions and Limitations section of the Certificate is amended to include the following exclusion: • Unauthorized services obtained by the Member that require pre-authorization by HMO including but not limited to Hospital admissions and outpatient surgery. Participating Providers are responsible for obtaining pre-authorization of Covered Benefits from HMO. The Exclusions and Limitations section of the Certificate is amended to include the following limitations: • Upon pre-authorization, other treatment plans may be subject to case management and a Member may be directed to specific Participating Providers for Covered Benefits including, but not limited to transplants and other treatment plans. • Supplemental plans provided under a separate contract or policy in addition to an HMO health benefit plan, including...
Sample 1See All (5)
Referred Services. A PHO or Contracted Provider may, in the course of an annual health check, refer an Eligible Person to the following Referred Services, if it is appropriate to do so: serum dioxin testing as set out in clause 6; foetal neural tube defect screening and genetic counselling as set out in clause 7; lifestyle improvement services, including smoking cessation, green prescriptions, and dietary information and advice; and mental health services for mild to moderate mental health conditions Serum dioxin test An Eligible Person may be referred for a serum dioxin test if: the Eligible Person has not previously had a serum dioxin test; the Eligible Person has been fully informed about the serum dioxin test at a consultation with his or her nominated General Practitioner, including the limitations and benefits of the serum dioxin test, the testing procedure, and the results are fully explained; the Eligible Person has been referred to a mental health counsellor to identify and address any concerns, and the mental health counsellor has referred the Eligible Person back to the General Practitioner for consideration for serum dioxin testing; the Eligible Person’s General Practitioner is satisfied that the serum dioxin test is not an unnecessary risk to the person and will assist with improving the person’s wellbeing; and the Eligible Person’s General Practitioner has, on behalf of the person, applied to the Ministry for the person to be referred for a serum dioxin test, and received confirmation from the Ministry that the application has been approved. If the Ministry approves an application, the Ministry will arrange a laboratory appointment and serum analysis. Foetal neural tube defect screening and genetic counselling The following persons may be referred for a foetal neural defect screen or genetic counselling or both as part of an annual health check: an Eligible Person: a pregnant woman if the biological father of the unborn child is an Eligible Person (whether or not the pregnant woman is an Eligible Person); and a child of an Eligible Person (whether or not the child is an Eligible Person). A person can be referred for foetal neural defect screening only by a General Practitioner, registered midwife, obstetrician, or family planning Practitioner. A person can be referred for genetic counselling only by a General Practitioner.
Sample 1Sample 2
Referred Services. For purposes of this Section, “referral” shall mean the act by a Provider providing services at a Health Center of identifying another health care provider and communicating information or a recommendation to a patient about that provider, as distinguished from a Provider exercising Provider’s professional judgment with respect to the diagnosis or treatment of a patient. Providers providing services at the Health Center shall exercise their professional judgment when referring patients for healthcare services. Neither LGMG nor the District will interfere with the professional judgment of the Providers at the Health Center in making such referrals. The District acknowledges and agrees that LGMG will have no responsibility or liability with respect to services provided by such healthcare providers. Notwithstanding the foregoing, LGMG agrees that, with respect to clinical laboratory specimens drawn at the Health Center for which testing is required by an off-site clinical laboratory, LGMG shall send such specimens to a clinical laboratory that participates in the District’s network unless referral to another clinical laboratory is preapproved by the District in writing.
Sample 1
Referred Services. For purposes of this Section, “referral” shall mean the act by a Provider providing services at a Health Center of identifying another health care provider and communicating information or a recommendation to a patient about that provider, as distinguished from a Provider exercising Provider’s professional judgment with respect to the diagnosis or treatment of a patient. Providers providing services at the Health Centers shall exercise their professional judgment when referring patients for healthcare services. Neither LGMG nor the Employer will interfere with the professional judgment of the Providers at the Health Centers in making such referrals. The Employer acknowledges and agrees that LGMG will have no responsibility or liability with respect to services provided by such healthcare providers.
Sample 1
Referred Services. If you are referred to another medical provider for specialized care, please be advised that such medical provider may have financial policies that differ from ours. Billing for medical services rendered by referred physicians, or labs (such as for a second pathology opinion) will be billed and handled by that provider. They may not be contracted with your insurance. The labs and Pathologists to whom we refer provide us trusted and expedient results.
Sample 1

Related to Referred Services

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • 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.

  • Shared Services 5.1.1 ETFO 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.

  • Marketing Services The Manager shall provide advice and assistance in the marketing of the Vessels, including the identification of potential customers, identification of Vessels available for charter opportunities and preparation of bids.

  • Hosting Services 13.1 If Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract Hosts Customer Data in connection with an Acquisition, the provisions of Appendix 1, attached hereto and incorporated herein, apply to such Acquisition.

  • Ongoing Services It is important to review every investment you hold and at regular intervals. At the time of, or prior to, our recommendation to you we will discuss our on-going service proposition. This is confirmed in our ‘service proposition and engagement’ document which will be sent to you separately from this agreement.

  • Managed Services HP will provide the services as described in a Statement of Work (“SOW”) attached to this Agreement or incorporating it by reference. Each party will appoint a single point of contact as set forth in the SOW who will serve as their primary representative, have overall responsibility for managing performance, and meet with the other party’s representative to review progress. Change requests are governed by the change management procedures as set forth in the SOW.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Standard Services As long as Tenant is not in default under any of the provisions of this Lease, Landlord shall cause the Leased Premises (in accordance with Section 12.3) and the public and common areas of the Building, including the lobbies, elevators, stairs, corridors and rest rooms, to be maintained in reasonably good order and condition consistent with the operation and maintenance of the Bank of America Building as a first-class office and retail building in downtown Bellevue, except for damage occasioned by any act or omission of Tenant or Tenant’s officers, contractors, agents, invitees, licensees or employees, the repair of which shall be paid for by Tenant. From 7:00 a.m. to 6:00 p.m. on weekdays, excluding legal holidays (“Regular Business Hours”), Landlord shall furnish the Leased Premises with electricity for lighting and operation of low power usage office machines, water, heat, air conditioning and elevator service (the “Standard Services”). During all other hours, Landlord shall furnish the Standard Services, including elevator service as reasonably required to provide access to the Leased Premises, except for heat and air conditioning and lighting. If requested by Tenant, Landlord shall furnish heat and air conditioning and lighting at times other than Regular Business Hours and the cost of such services, as established by Landlord, shall be paid by Tenant in the same manner as provided in Section 5 above. Landlord also shall provide lamp replacement service for Building Standard fluorescent light fixtures, toilet room supplies, window washing at reasonable intervals and customary building janitorial service as part of the Standard Services, although no janitorial service shall be provided for Saturdays, Sundays or legal holidays. The cost and expense of any janitorial or other services provided or caused to be provided by Landlord to Tenant in addition to the services ordinarily provided Bank of America Building tenants shall be paid by Tenant in the same manner as provided for payment in Section 5 above.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!