Delivery Network Clause Samples

Delivery Network. In addition to the benefits described in the sections above, the Contractor shall also cover services in the following situations: • The Contractor shall provide for a second opinion from a Participating Provider or arrange for the Dental Health Plan Enrollee to obtain a second opinion outside the network, at no cost to the Dental Health Plan Enrollee, in accordance with 42 C.F.R. § 438.206(b)(3). • If the Contractor's provider network is unable to provide necessary medical services covered under the Contract to a particular Dental Health Plan Enrollee, the Contractor must adequately and timely cover the services out of network, for as long as the Contractor’s provider network is unable to provide them, in accordance with 42 C.F.R. § 438.206(b)(4). The Contractor shall coordinate payment with Non-Participating Providers and ensure the cost to the Dental Health Plan Enrollee is no greater than it would be if the services were furnished within the network.