Common use of Special Coverage Clause in Contracts

Special Coverage. 11.3.9.1 In order to obtain services under Special Coverage, an Enrollee must register, as provided in Section 7.7.6 of this Contract. Registration is a form of utilization control, to determine whether the Enrollee’s health condition warrants Access to the expanded services included in Special Coverage. 11.3.9.2 In addition, as noted in Section 7.7.12 of this Contract, some individual Special Coverage services require Prior Authorization for an Enrollee who has registered under Special Coverage.

Special Coverage. 11.3.9.1 11.4.9.1 In order to obtain services under Special Coverage, an Enrollee must registershall be registered in the program, as provided in Section 7.7.6 of this Contract7.7. Registration is a form of utilization Utilization control, to determine whether the Enrollee’s health condition warrants Access to the expanded services included in Special Coverage. 11.3.9.2 . In addition, as noted in Section 7.7.12 of this Contract7.7.12, some individual Special Coverage services require Prior Authorization even for an Enrollee Enrollees who has have registered under Special Coverage.