Covered Services in Special Circumstances definition

Covered Services in Special Circumstances means Covered Services provided by a Medical Group Participating Provider following termination to a Member who is undergoing a course of treatment from the Participating Provider for an acute condition, serious chronic condition, high-risk pregnancy, or a pregnancy that has reached the second or third trimester at the time of termination. The foregoing definition shall be interpreted in a manner consistent with applicable law, including California Health and Safety Code Section 1373.96.
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Examples of Covered Services in Special Circumstances in a sentence

  • Following termination of this Agreement, Medical Group shall, at the request of the applicable Member and in accordance with PacifiCare’s policies and procedures, assure that all of its Participating Providers shall provide Covered Services in Special Circumstances to Members as required by this Section 8.3.3.

  • Without limiting any other provision of this Agreement, all of Medical Group’s subcontracts shall contain the requirements set forth at Sections 8.3.3 of this Agreement pertaining to the provision of Covered Services in Special Circumstances.

  • Following the termination of any Medical Group Participating Provider, Medical Group shall, at the request of the applicable Member and in accordance with PacifiCare’s policies and procedures, assure that such Participating Provider shall provide Covered Services in Special Circumstances to Members as required by this Section 8.3.3.

  • Without limiting any other provision of this Agreement, all of Medical Group’s subcontracts shall contain the requirements set forth in Sections 8.3.3 of this Agreement pertaining to the provision of Covered Services in Special Circumstances and shall provide that Medical Group’s Participating Providers shall look solely to Medical Group for payment for Covered Services provided to Medical Group Members.

  • In the event of termination of this Agreement, Medical Group shall provide information to PacifiCare to identify Members who may be eligible for Covered Services in Special Circumstances from a Medical Group Participating Provider.

  • Medical Group shall be solely responsible for compensating any terminated Participating Provider for the provision of Covered Services in Special Circumstances to Members as agreed upon in writing between the terminated Participating Provider and Medical Group or at the rate and method of payment used by Medical Group for its contracting providers providing similar services who are not capitated and who are practicing in the same or a similar geographic area as the terminated Participating Provider.

  • Following the enrollment of a New Member into a PacifiCare health plan, Medical Group shall, at the request of such New Member and in accordance with PacifiCare’s policies and procedures, assure that the applicable Nonparticipating Provider shall provide Covered Services in Special Circumstances to New Members as required by this Article IV.

  • Following the Termination of any Participating Provider, Medical Group shall, at the request of the applicable Member and in accordance with PacifiCare’s policies and procedures, assure that such Participating Provider shall provide Covered Services in Special Circumstances as required by this Article IV.

  • Following the Termination of the Agreement, Provider shall, at the request of the applicable Member and in accordance with VOC’s policies and procedures, continue to provide Covered Services in Special Circumstances to Members as required by this Article III.

  • Provider shall continue to provide Covered Services in Special Circumstances to Members, at the rates and pursuant to the requirements specified in the Agreement, at the time of Termination of the Agreement until the course of treatment is completed in accordance with the time periods in Section 3.4 of this Notice Amendment.

Related to Covered Services in Special Circumstances

  • Reimbursement Under Special Circumstances means a special reimbursement of the Deposits, prior to the Maturity Date, in the circumstances and the manner described under “Extraordinary Events and Special Circumstances – Reimbursement Under Special Circumstances and Payment”.

  • Special Circumstances means either or both of the following:

  • Covered Services means all or a part of those medical and health services set forth in rule 441—86.14(514I).

  • Exceptional Circumstances : shall mean one or more unavoidable circumstances, as determined by the ISO, that individually or collectively render as unavailable the data necessary for the ISO to perform an audit and review of a Market Party, pursuant to Section 23.4.5.6.2 of this Services Tariff. Exceptional Circumstances may include, but are not limited to: the inaccessibility of the physical facility; the inaccessibility of necessary documentation or other data; and the unavailability of information regarding the regulatory obligations with which the Market Party will be required to comply in order to return its Generator to service which regulatory obligations are not yet known but which will be made known by the applicable regulatory authority under existing laws and regulations provided that none of the above described circumstances are the result of delay or inaction by the Market Party. The magnitude of the repair cost, alone, shall not be an Exceptional Circumstance.

  • Extenuating Circumstances means the inability to perform at an optimum level arising from one or more of the reasons set out in clause 6.1.

  • Special Circumstance means an event where, in the opinion of the Bank acting reasonably and in good faith, an amendment or a change is made to a taxation act or regulation, to taxation practices, policies or administration, to the interpretation of a taxation act or regulation or taxation practice, policy or administration; or an event occurs, now or in future, caused by circumstances beyond the control of the Bank making it illegal or disadvantageous, from a legislative or regulatory point-of-view, or disadvantageous, from a financial point- of-view, for the Bank to allow the Deposits of such series to remain outstanding. As provided hereunder, certain other extraordinary events affecting the underlying interest may be deemed to constitute a Special Circumstance and entitle the Bank to proceed with a Reimbursement Under Special Circumstances.

  • Exigent Circumstances means circumstances where collection or disclosure is urgently necessary, such that procedures that would otherwise be required cannot be followed.

  • Disaster Recovery Services means the Services embodied in the processes and procedures for restoring the provision of Services following the occurrence of a Disaster, as detailed further in Call Off Schedule 8 (Business Continuity and Disaster Recovery);

  • Information Service Traffic Traffic delivered to or from an Information Service Provider for the provision of Information Service. ISP-Bound Traffic is a subset of Information Service Traffic. Inside Wire or Inside Wiring: Wiring within the customer Premises that extends to the Demarcation Point of CenturyLink’s outside plant. Inside Wire is owned or controlled by the End User (unless otherwise specified herein or under Applicable Law).

  • Aggravated circumstances means circumstances in which a parent:

  • Scope of Services or “Scope of Work” means the work to be performed by the Proposer or Consultant as described in Section 2.0 of this RFP, as amended thereto.

  • Transition Services Agreements has the meaning set forth in Section 7.01(h).

  • Finished Services means complete end-to-end services offered by Qwest to wholesale customers or retail End User Customers. Finished Services do not include Unbundled Network Elements or combinations of Unbundled Network Elements. Finished Services include Access Services, private lines, retail services, and resold services.

  • Business Continuity and Disaster Recovery Plan means the Schedule containing plans and provisions for business continuity and disaster recovery.

  • Hosted Services means the hosting, management and operation of the computing hardware, ancillary equipment, Software, firmware, data, other services (including support services), and related resources for remote electronic access and use by the State and its Authorized Users, including any services and facilities related to disaster recovery obligations.

  • Basic generation service transition costs means the amount by

  • Transition Services Agreement means the transition services agreement substantially in the form attached hereto as Exhibit B.

  • Extraordinary Circumstances means floods, snow, ice storms, tornadoes, earthquakes, or other

  • Disaster recovery project means a project located on property

  • Covered Personnel means any Person who is or was an employee, consultant or independent contractor of the Covered Parties as of the date of the relevant act prohibited by this Section 2(a) or during the one (1) year period preceding such date.

  • Material Change in Content means the occurrence since the Launch Date of a material change in the content, composition or constitution of the Futures Contract or the Commodity.

  • Rehabilitation counseling services means services provided by qualified personnel in individual or group sessions that focus specifically on career development, employment preparation, achieving independence, and integration in the workplace and community of a student with a disability. The term also includes vocational rehabilitation services provided to a student with disabilities by vocational rehabilitation programs funded under the Rehabilitation Act of 1973, as amended.

  • Counseling services means services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel.

  • Specified Personnel means the personnel specified in the Contract to provide the Services.

  • Routine patient care costs means Covered Medical Expenses which are typically provided absent a clinical trial and not otherwise excluded under the Policy. Routine patient care costs do not include:

  • Exigent Circumstance means a Covered Person either has a Condition that may seriously jeopardize his or her life, health, or ability to regain maximum function or is undergoing a current course of treatment using a non-Formulary medication. The request for an expedited review should include the following support: