Examples of HMO Member in a sentence
Group Participating Providers are required to refer BlueLincs HMO Members to BlueLincs HMO Participating Providers unless, in Group Participating Provider's best medical judgment, there is no BlueLincs HMO Participating Provider who can provide the Medically Necessary services needed for a BlueLincs HMO Member.
Non-Network Providers must be approved by BlueLincs HMO prior to ordering services on behalf of the BlueLincs HMO Member.
The process BlueLincs HMO Participating Providers follow to obtain authorization from BlueLincs HMO when a BlueLincs HMO Member needs specific Medically Necessary services which are unavailable within his/her network.
If Group discontinues providing care for a BlueLincs HMO Member, Group will provide the BlueLincs HMO Member and BlueLincs HMO sixty (60) calendar days advance written notice of Group's discontinuance of care, and must continue to provide care for such BlueLincs HMO Member during such sixty (60) calendar day period or until the BlueLincs HMO Member selects a new provider.
Such Written Waiver must specifically identify the services for which the BlueLincs HMO Member or his or her representative agrees to be financially responsible and must be executed before Group Participating Provider renders such services.
The Group Participating Provider may submit an Out of Network Request when a BlueLincs HMO Member needs Medically Necessary services which are unavailable within his/her network by contacting BlueLincs HMO's Prior Authorization Department as set forth in Article VI of the Agreement.
The Group Participating Provider shall also provide complete information on authorized care or services to the out of network provider to whom the BlueLincs HMO Member is being referred.
Group may not bill or collect from the BlueLincs HMO Member for the aforementioned services.
In the event that Group Participating Provider shall provide Noncovered Services, Group Participating Provider shall, prior to rendering such Noncovered Services, (a) inform the BlueLincs HMO Member that (1) the service(s) to be provided are not covered; (2) BlueLincs HMO will not pay for or be liable for said services; (3) the BlueLincs HMO Member will be financially liable for such services, and (b) obtain a Written Waiver as defined in the Agreement.
Group agrees to ensure that Group Participating PCPs encourage BlueLincs HMO Member participation in various health education and health maintenance programs offered by and through BlueLincs HMO to promote achieving and maintaining a healthy lifestyle to the BlueLincs HMO Members.