Twenty-Four Hour Coverage Sample Clauses

Twenty-Four Hour Coverage. DVHA must ensure that emergency coverage is available to enrollees on a twenty-four hour per day, seven-day per week basis. Coverage may be delegated to subcontractors, including IGA partners, but DVHA must maintain procedures for monitoring coverage to ensure twenty-four-hour availability.
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Twenty-Four Hour Coverage. The Contractor must provide access to medical and behavioral health services and coverage to members either directly or through their PCP on a twenty-four (24) hours a day, seven (7) days a week basis. The Contractor must educate members on how to access services after regular business hours and on weekends. The Contractor may satisfy this requirement by requiring all PCPs to assume the primary responsibility for 24/7 after hours on call telephone services.
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Twenty-Four Hour Coverage. The Contractor shall maintain adequate provider network coverage to serve the entire eligible FAMIS populations in geographically accessible locations within the region twenty-four (24) hours per day, seven (7) days a week. The Contractor shall make arrangements to refer patients seeking care after regular business hours to a covering physician or shall direct the member to go to the emergency room when a covering physician is not available. Such referrals may be made via a recorded message. In accordance with the Code of Virginia § 38.2 - 4312.3 as amended, the Contractor shall maintain after-hours telephone service, staffed by appropriate medical personnel, which includes access to a physician on call, a primary care physician, or a member of a physician group for the purpose of rendering medical advice, determining the need for emergency and other after-hours services, authorizing care, and verifying member enrollment with the Contractor.
Sample 1
Twenty-Four Hour Coverage. The OVHA must ensure that coverage is available to enrollees on a twenty-four hour per day, seven day per week basis. Coverage may be delegated to the subcontracted Departments, but the OVHA must maintain procedures for monitoring coverage to ensure twenty-four hour availability. The OVHA will collaborate with the AHS to develop a toll-free Nurse Advice Line, through which enrollees with urgent or emergent medical problems can obtain guidance twenty-four hours per day, seven days per week.
Sample 1
Twenty-Four Hour Coverage. The Contractor shall maintain adequate provider network coverage to serve the entire eligible FAMIS populations in geographically accessible locations within the region twenty-four (24) hours per day, seven (7) days a week. The Contractor shall make arrangements to refer patients seeking care after regular business hours to a covering physician or shall direct the member to go to the emergency room when a covering physician is not available. Such referrals may be made via a recorded message. In accordance with the Code of Virginia § 38.2 - 4312.3 as amended, the Contractor shall maintain after-hours telephone service, staffed by appropriate medical personnel, which includes access to a physician on call, a primary care physician, or a member of a physician group for the purpose of rendering medical advice, determining the need for emergency and other after-hours services, authorizing care, and verifying member enrollment with the Contractor.
Sample 1

Related to Twenty-Four Hour Coverage

  • When Your Coverage Begins Your coverage will begin on the first day of the month following your eligibility date as long as we receive required enrollment information within the first thirty (30) days following your eligibility date and the premium is paid. If you or your dependents fail to enroll at this time, you cannot enroll in the plan unless you do so through an Open Enrollment Period or a Special Enrollment Period.

  • ELIGIBILITY FOR COVERAGE Any employee and the dependents of an employee who meet and continue to meet the eligibility requirements described in this Contract, will be entitled to apply for coverage under this Contract. These eligibility requirements are binding upon you and your eligible dependents. We may require acceptable documentation that an individual meets and continues to meet the eligibility requirements (e.g. proof of residency, copies of a court order naming the Subscriber as legal guardian, or appropriate adoption documentation, as described in Part IV. ENROLLMENT AND EFFECTIVE DATE OF COVERAGE).

  • When Your Coverage Ends Coverage under this plan is guaranteed renewable. It can only be canceled by us for the following reasons: • if you leave your place of employment; • if you decide to discontinue coverage. Inform your employer prior to the requested date of cancellation and your employer will notify us. If we do not receive your notice prior to the requested date of cancellation, you or your employer may be responsible for paying another month’s premium; • if the required premium is not paid within one month of the due date. We will mail you a notice of discontinuance along with information about enrolling in an individual healthcare plan; • if you or a covered dependent no longer qualifies as an eligible person; • if we no longer offer this type of coverage; • if your employer contracts with another insurer or entity to provide or administer benefits for the covered healthcare services provided by this agreement; • if fraud is determined by us. See Rescission of Coverage section below for additional details; If your healthcare coverage is terminated for one of the reasons listed above, we will send you a termination notice thirty (30) days before the termination date. The notice will indicate the reason why your healthcare coverage has ended. When your coverage ends, you may apply for individual healthcare coverage directly from BCBSRI or through HSRI. You must meet the eligibility requirements and we must receive required enrollment information within sixty (60) days from the date your group coverage ended along with required premium. If you do not reside in Rhode Island, you are not eligible to enroll in an individual plan from BCBSRI or HSRI. You may be able to obtain coverage through an insurance company in the state in which you reside. Rescission is a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation is not a rescission if it: • only has a prospective effect (as described above); or • is due to non-payment of premiums, which can have a retroactive cancellation effect. We may rescind your coverage if you or your dependents commit fraud. Fraud includes, but is not limited to, intentional misuse of your identification card (ID card) or intentional misrepresentation of a material fact. Any benefit paid in the past will be voided. You will be responsible to reimburse us for all costs and claims paid by us. We must provide you a written notice of a rescission at least thirty (30) days in advance. Except for non-payment, we will not contest this policy after it has been in force for a period of two (2) years from the later of the effective date of this agreement or the latest reinstatement date.

  • Basic Coverage Contractor shall provide and maintain at the JBE’s discretion and Contractor’s expense the following insurance during the Term:

  • Minimum scope of coverage Commercial general coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. Automobile coverage shall be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 (“any auto”). No endorsement shall be attached limiting the coverage.

  • 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.

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