Exclusive Provider definition

Exclusive Provider means a health care provider or group of providers who have

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Exclusive Provider means a provider of health care, or a group of providers of health care, that has entered into a written agreement with the insurer to provide benefits under his section, which agreement shall include any health care provider listed in s. 627.419(3) and (4) and shall provide reasonable access to such health care providers.

Exclusive Provider means the only entity authorized to provide the relevant service or facility and to charge fees, costs or other monies for such service or facility. The term “Exclusive Provider” shall not be construed to require the entity to generate the service or facility and specifically permits the entity to provide such service or facility after it has purchased the service or facility from another entity,

Examples of Exclusive Provider in a sentence

• In this section, a Plan that bases benefits on a negotiated fee schedule is called a “Fee Schedule Plan.” An HMO and Exclusive Provider Organization (EPO) are examples of network only plans that could use a fee schedule.

• In this section, a Plan that pays providers based upon capitation is called a “Capitation Plan.” In the rules below, “provider” refers to the provider who provides or arranges the services or supplies and “HMO” refers to a health maintenance organization plan, and “EPO” refers to Exclusive Provider Organization.

• Examples of such plans are Health Maintenance Organization plans (HMO) and Exclusive Provider organization plans (EPO).

• In this section, a Plan that pays providers based upon capitation is called a “Capitation Plan.” In the rules below, “provider” refers to the provider who provides or arranges the services or supplies and “HMO” refers to a health maintenance organization plan and “EPO” refers to Exclusive Provider Organization.

• Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) medical plans, and PPO and Dental Maintenance Organization (DMO) dental plans shall be available to employees.

• As of implementation of the changed plans in 2010, the only such plans are the Preferred Provider Organization (PPO) plan, the Exclusive Provider Organization (EPO) plan, and the Basic Exclusive Provider Plan (Basic EPO) with plan designs attached and identified as PPO, EPO and Basic EPO.

• Insureds enrolled under SHL’s Exclusive Provider Organization (EPO) Plans who use the services of Non-Plan Providers will receive no benefit payments or reimbursement for amounts for any Covered Service, except  in the case of Emergency Services or Urgently Needed Services or  other Covered Services provided by a Non-Plan Provider that are Prior Authorized by SHL’s Managed Care Program.

• Unit members shall be eligible to select a medical plan and a dental plan from the following medical and dental selections: Kaiser HMO (Health Maintenance Organization); EPO (Exclusive Provider Organization); PPO (Preferred Provider Organization); Delta Dental Premier, MetLife, or Preferred Advantage Dental.

• The District shall offer health insurance with at least: One Exclusive Provider Organization (EPO) Beginning with the February 1, 2021 paycheck the District shall pay seventy-five percent (75%) of the EPO premium for Employee Only coverage and seventy percent (70%) for all other premium tiers of the plan (employee + spouse, employee + child(ren) and family).

• The District will provide health insurance through the Blue Cross EPO (Exclusive Provider Organization) and the Blue Cross PPO (Preferred Provider Organization) plans.

More Definitions of Exclusive Provider

Exclusive Provider refers to the Provider’s selection as the sole specialty pharmacy mail order provider for BCBSM and BCN’s Specialty Pharmacy program. This term does not mean that BCBSM and BCN, Members or Physicians must obtain these products and services exclusively from the Provider.

Exclusive Provider means an individual provider, which is chosen by the Member or assigned by the Division to provide all medically necessary Federal and State reimbursable drugs to theMember.

Exclusive Provider. Means that CCPN shall be the sole provider, either directly or through contracted Health Care Professionals or institutions for Institutional Services, of all pediatric health services for HMO in the STAR Program in the Service Area.