CLAIM FILING AND PROVIDER PAYMENTS This section provides information regarding how a member may file a claim for a covered healthcare service and how we pay providers for a covered healthcare service. Network providers file claims on your behalf. Non-network providers may or may not file claims on your behalf. If a non-network provider does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the provider’s itemized bill, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the provider who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered healthcare service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated. We pay network providers directly for covered healthcare services. Network providers agree not to bill, charge, collect a deposit from, or seek reimbursement from you for a covered healthcare service, except for your share under the plan. When you see a network provider, you are responsible for a share of the cost of covered healthcare services. Your share includes the deductible, if one applies, and the copayment, as listed in the Summary of Medical Benefits. The covered healthcare service may also have a benefit limit, which caps the amount we will reimburse the provider for that service. You will be responsible for any amount over the benefit limit, up to the allowance. Your provider may request these payments at the time of service, or may bill you after the service. If you do not pay your provider, the provider may decline to provide current or future services or may pursue payment from you, such as beginning collection proceedings. Some of our agreements with network providers include alternative payment methods such as incentives, risk-sharing, care coordination, value-based, capitation or similar payment methods. Your copayments are determined based on our allowance at the date the service is rendered. Your copayment may be more or less than the amount the network provider receives under these alternative payment methods. Your copayment will not be adjusted based on these alternative payment methods, or for any payment that is not calculated on an individual claim basis. Our contracts with providers may establish a payment allowance for multiple covered healthcare services, and we may apply a single copayment based on these arrangements. In these cases, you will typically be responsible for fewer copayments than if your share of the cost had been determined on a per service basis.
Ordering and Provisioning 53.3.1 CenturyLink will provide necessary ordering and provisioning business process support as well as those technical and systems interfaces as may be required to enable CLEC to provide resale services, including the functions, features, and capabilities of such services, and Unbundled Network Elements. If CenturyLink deploys any enhanced electronic capability CenturyLink will notify CLEC of availability and CLEC shall use the processes for performing transaction(s) to the extent practicable and the use of any other interface or process will be discontinued. 53.3.2 The Parties agree that orders for services under this Agreement will not be submitted or accepted until thirty (30) Days after the completion of all account establishment activities, including but not limited to, the documents and information subscribed in Section 45.1, unless the Parties mutually agree upon a different date based on the specific circumstances of the Parties’ relationship. 53.3.3 Except as specifically provided otherwise in this Agreement, pre- ordering, ordering and provisioning of resold services shall be governed in accordance with CenturyLink’s Standard Practices. 53.3.4 CenturyLink will provide provisioning intervals and procedures for design and complex services on a nondiscriminatory basis. Complex Service Order charges pursuant to Tariff terms may apply. 53.3.5 Where Technically Feasible, the NEAC will coordinate support for all designed and/or complex services provided to CLEC. 53.3.6 To the extent required by Applicable Law, and upon request from CLEC, employing CenturyLink’s LSR, CenturyLink will provide blocking of 700, 900, and 976 services, or other services of similar type as may now exist or be developed in the future, and shall provide Billed Number Screening (BNS), including required LIDB updates, or equivalent service for blocking completion of bill-to-third party and collect calls, on a line, PBX, or individual service basis. Blocking shall be provided to the extent (a) it is an available option for the Telecommunications Service resold by CLEC, or (b) it is Technically Feasible when requested by CLEC as a function of Unbundled Network Elements. 53.3.7 When ordering a resale service via an LSR Service Order, CLEC may order separate interLATA and IintraLATA service providers (i.e., two PICs) on a line or trunk basis, and CLEC agrees to pay the applicable Service Order and PIC charges associated with such order. CenturyLink will accept PIC change orders for IntraLATA toll and long distance services through the service provisioning process. 53.3.8 The standard Service Order charges as listed in the Table 1 of this Agreement shall apply to all orders.
FACTS AND PROVISIONS/LEGAL REQUIREMENTS The term of the Agreement shall be from September 1, 2015, through May 31, 2018. The County may terminate its participation in the Agreement by providing 90 days advance written notice to the other participating agencies. The Department will provide its personnel assigned to OPSG Grant Program with all supplies and/or prescribed safety gear, body armor, and/or standard issue equipment necessary to perform OPSG Grant Program activities. The County agrees to defend and indemnify the County of San Diego for any claim, action, or proceeding against the County of San Diego arising solely out of the acts or omissions of the County in the performance of the Agreement. Each party to the Agreement agrees to defend itself from any claim, action, or proceeding arising out of concurrent acts or omissions of the parties. In such a case, each party agrees to retain its own legal counsel, bear its own defense costs, and waive its right to seek reimbursement of such costs except where a court finds and allocates comparative fault. Board approval is required for this Agreement, as the funding amount exceeds the authority previously delegated by the Board to the Sheriff on May 15, 2015. County Counsel has approved the attached Agreement as to form. The Honorable Board of Supervisors 5/17/2016
DUŠEVNÍ VLASTNICTVÍ The Institution and the Investigator acknowledge and agree that the Sponsor shall have exclusive ownership rights to all Study Data, improvements, developments, discoveries, inventions, work, know- how and other rights (whether or not patentable), created, developed, and/or reduced to practice as a result of or in connection with the conduct of the Study and/or the use of the Study Drug or the Confidential Information, together with all intellectual property rights relating thereto (“Intellectual Property”). The Institution and the Investigator shall promptly disclose in writing to the Sponsor all Intellectual Property made by the Institution, the Investigator and/or the Study Personnel. At the Sponsor's request, the Institution and the Investigator shall cause all rights titles and interests in and to any such Intellectual Property to be assigned to the Sponsor without additional compensation and provide reasonable assistance to obtain patents, including causing the execution of any invention assignment or other documents. In case, for legal or factual reasons, the Institution and Zdravotnické zařízení a Hlavní zkoušející uznávají a souhlasí, že Zadavatel bude mít výhradní vlastnická práva ke všem Studijním údajům, vylepšením, na vývoj, k objevům, vynálezům, dílům, know-how a dalším právům (ať už patentovatelným či nikoli), vytvořeným, vyvinutým, a/nebo uvedeným do praxe v důsledku nebo v souvislosti s prováděním Studie, a/nebo používáním Studijního léku nebo Důvěrných informací společně s právy duševního vlastnictví s nimi souvisejícími (dále jen „Duševní vlastnictví“). Zdravotnické zařízení a Hlavní zkoušející budou neprodleně písemně informovat Zadavatele o veškerém Duševním vlastnictví vytvořeném Zdravotnickým zařízením, Hlavním zkoušejícím a/nebo Studijním personálem. Na žádost Zadavatele zajistí Zdravotnické zařízení a Hlavní zkoušející převod veškerých práv a zájmů týkajících se Duševního vlastnictví na Zadavatele bez další odměny a poskytnou přiměřenou součinnost k získání patentu včetně zajištění podpisu dokumentů k převodu objevu nebo jiných dokumentů. V případě, kdy z právních nebo the Investigator can’t cause all rights titles and interests in and to any such Intellectual Property to be assigned to the Sponsor, they shall provide the Sponsor with a royalty free license to the same extend. věcných důvodů Zdravotnické zařízení a Hlavní zkoušející nebudou moci zajistit převedení všech vlastnických práv a zájmů týkajících se Duševního vlastnictví na Zadavatele, jsou povinni poskytnout ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇.
WILD AND SCENIC RIVERS The Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1271, et seq.) as amended, particularly sections 7(b) and (c) (16 U.S.C. § 1278(b) and (c)). AIR QUALITY The Clean Air Act (42 U.S.C. § 7401, et seq.) as amended, particularly sections 176(c) and (d) (42 U.S.C. §7506(c) and (d)). Determining Conformity of Federal Actions to State or Federal Implementation Plans (Environmental Protection Agency-40 C.F.R. Parts 6, 51, and 93).