RIGHT TO CHOOSE. 1. Each principal subscriber shall have the right to select an HCO from those available in the health Area/Region which at no time will be less than two (2) HCO's at each municipality, one of which has to be a privatized or non-privatized government or municipal facility if available, and subject to compliance with INSURER's requirements for HCO's. The selection of the HCO and primary care physician will be made by the beneficiaries at the INSURER's local or regional offices. The right of beneficiaries to transfer or change from an HCO shall be made at any time without cause during the first 90 days following the date of the
RIGHT TO CHOOSE. 1. Each principal subscriber shall have the right to select an HCO from those available in the health Area/Region which at no time will be less than two (2) HCOs at each municipality, one of which has to be a privatized or non-privatized government or municipal facility if available, and subject to compliance with INSURER's requirements for HCO's. The selection of the HCO or primary care physician will be made by the beneficiaries at the insurance regional offices. The right of beneficiaries to transfer or change from an HCO shall be made at any time without cause during the first 90 days following the date of the beneficiary's initial enrollment or the date of enrollment notice is sent, whichever is later, and at most once every twelve (12) months thereafter, and for any of the causes of disenrollment set forth on 42 CFR 438.56 at any time.
2. Each HCO will have available at least one of each specialist considered a primary care physician and shall meet the specification of the ratio specified in Article VI, and will have a sufficient number of primary care physicians to provide health care services to all beneficiaries according to the ratio specified in Article VI. Furthermore, the INSURER will provide to each HCO a network with a sufficient number of participating providers to render all services included under the basic, special and dental coverage to beneficiaries pursuant to the ratio specified in Article VI.
3. The beneficiary shall have the right to choose his or her primary care physician from those available within the HCO selected by the principal subscriber. Said right also encompasses the change of the selected primary physician at any time by making the proper administrative arrangements within the HCO in conformity with the HCO's established policy. The selected primary care physician or the substitute on-duty primary care physician within the HCO must be available on a 24 hour basis for emergencies and/or telephone consultations. Each HCO must have available all of the primary care physicians (family physicians, internists, general practitioners, pediatricians and obstetrician-gynecologist) subject to waivers in case of unavailability of a specific provider.
4. A primary care physician can only act as such in only one (1) municipality within the Health Area/Region subject of this contract and must be available to attend the health care needs of the beneficiary on a twenty four (24) hour basis, seven (7) days a week.
5. A primary care physi...
RIGHT TO CHOOSE. You have the right to choose a counselor/therapist who best suits your needs and purposes. At any time feel free to discuss with me any questions you have regarding my qualifications, practice, course of treatment and/or intervention techniques, or any other issues or questions you may have regarding our work together. Education, Training and Experience: Theoretical Orientation: My therapeutic interventions and methodologies are based primarily on Family Systems Therapy and Cognitive-Behavioral Therapy.
RIGHT TO CHOOSE. You have the right to decide not to receive services with me. If you wish, I will provide you with names of other qualified professionals.
RIGHT TO CHOOSE. Employees have the right to choose a Fund. If employees do not make a choice, contributions will be made into a Fund nominated by Ego.
RIGHT TO CHOOSE. 1. Each principal subscriber shall have the right to select an HCO from those available in the health Area/Region which at no time will be less than two (2) HCO’s at each municipality, one of which has to be a privatized or non-privatized government or municipal facility if available, and subject to compliance with INSURER’s requirements for HCO’s. The selection of the HCO and primary care physician will be made by the beneficiaries at the INSURER’s local or regional offices.
2. Each HCO will have available at least one of each specialist considered a primary care physician, and shall meet the network and ratio criteria all the services specified in this Contract. Furthermore, the INSURER will provide to each HCO a network with a sufficient number of participating providers to render all services included.
3. The beneficiary shall have the right to choose his or her primary care physician from those available within the HCO selected by the principal subscriber. Said right also encompasses the change of the selected primary physician at any time by making the proper administrative arrangements within the HCO in conformity with the HCO’s established policy. The selected primary care physician or the substitute on-duty primary care physician within the HCO must be available on a 24 hour basis for emergencies and/or telephone consultations. Each HCO must have available all of the primary care physicians (family physicians, internists, general practitioners, pediatricians and obstetrician-gynecologist) subject to waivers in case of unavailability of a specific provider.
4. A primary care physician may only act as such in one (1) municipality and only one (1) HCO within the Health Area/Region subject of this contract. The ADMINISTRATION may, at its sole discretion, allow a primary care physician act as such in up to two (2) HCOs as long as it is in the same Health Area/Region, in the same municipality, and the ratio of 1:1,700 established in is not exceeded. The primary care physician and he/she or a designated substitute shall be available to attend the health care needs of the beneficiary on a twenty four (24) hour basis, seven (7) days a week.
5. Each female beneficiary may select (i) primary care physician, or (ii) primary care physician and obstetrician-gynecologist as her primary care physician. If the female is pregnant, the obstetrician-gynecologist automatically will become the primary care physician; if one is not previously selected, she will then hav...
RIGHT TO CHOOSE. 1. The beneficiary shall have the right to choose his or her mental health provider from those available within the MBHO. Said right also encompasses the change of the selected mental health provider at any time by making the proper administrative arrangements within the MBHO in conformity with the MBHO established policy. The selected mental health provider or the SUBSTITUTE on-duty within the MBHO must be available on a 24-hour basis for emergencies and/or telephone consultations. Each MANAGED BEHAVIORAL HEALTH ORGANIZATION must have available on-call mental health providers at all times.
2. The MBHO must be available to attend the health care needs of the beneficiary on a twenty-four (24) hour basis, seven (7) days a week.
3. The MBHO will provide to each principal subscriber a complete list of all participating physician psychiatrists, psychologists and participating providers, with addresses and specialties of mental health related services offered, in order to allow the beneficiary to choose among them:
4. The beneficiary shall also have the right to choose the pharmacy within the network of pharmacies registered within PBM's network of pharmacy providers. The pharmacy benefits under the mental health coverage will be administered and managed by ADMINISTRATIONS' Pharmacy Benefits Manager according to the guidelines established and set forth by ASSMCA and the ADMINISTRATION's Pharmacy and Therapeutic Committee. Any new guidelines shall become effective sixty (60) days after notice to the MBHO. The ADMINISTRATION will determine the acceptable pharmacy/beneficiary ratio in order to assure access to the pharmacy benefits. The right to choose requires the availability of sufficient number of pharmacies in each municipality of residence of the beneficiaries.
RIGHT TO CHOOSE. 3.2.1 Each principal subscriber must have the right to select an HCO from those available in the Metro-North Region. The right of beneficiaries to transfer or change from an HCO shall be exercised orally or in writing to TPA by the enrollee at any time, without cause, during the first 90 days following the date of the enrollee’s initial enrollment or the date enrollment notice is sent to THE ADMINISTRATION, whichever is later, and at most once every twelve (12) months thereafter. An enrollee may change his/her enrollment for cause, at any time, for the following reasons: (1) the enrollee moves out of the area of service of the HCO and is not within a reasonable distance from the area of service of the HCO; (2) the HCO does not cover the service because of moral or religious objections; (3) the enrollee needs related services to be performed at the same time; not all related services are available within the network; and the enrollee’s primary care provider or another provider determines that receipt of services separately would subject the enrollee to unnecessary risk; and, (4) other reasons, including but not limited to, poor quality of care and lack of access to experienced providers capable of handling the enrollee’s health care needs. The enrollee shall assure proper written or oral notification of his/her desire to exercise the right to change from HCO, in a standard form to be provided by TPA, at least 60 days prior to the end of each 12 month enrollment period.
3.2.2 Each HCO network will have available at least one of each specialist considered a primary care physician, and shall meet the network and ratio criteria specified in Section 3.3 for all the services specified in this Contract. Furthermore, the ADMINISTRATION expects that TPA establish and contract with networks of Medical Groups and Mental Health Care Providers for the region (HCOs, EPOs, and PPOs, as applicable; sufficient to satisfy the GHIP population needs.
3.2.3 The enrollee shall have the right to choose his or her primary care physician from those available within the HCO selected by the principal enrollee. Said right also encompasses the change of the selected primary physician at any time by making the proper administrative arrangements within the HCO in conformity with the HCO’s established policy. The TPA or HCO, as applicable, shall guarantee that providers, including, but not limited to, the selected primary care physician or the substitute on-duty primary care physician wit...
RIGHT TO CHOOSE. All employees have the right to choose the fund in respect of all superannuation contributions made on their behalf.
