GAMC Covered Services Sample Clauses

GAMC Covered Services. The MCO shall provide, or arrange to have provided, to Enrollees comprehensive preventive, diagnostic, therapeutic and rehabilitative health care services as defined in Minnesota Statutes, § 256D.03, until the funding for the GAMC program is suspended. Except for sections 6.2.16(C) and 6.2.17, or as otherwise specified in the Contract, these services shall be provided to the extent that this law was in effect on the effective day of this Contract. Sections 6.2.16(C) and 6.2.17 shall be provided to the extent that the above law and rules are in effect. Pursuant to section 6.8.1, all covered benefits, except for services mandated by state or federal law, are subject to determination by the MCO of Medical Necessity, as defined in section 2.60. For purposes of this section, mandated services do not include the benefits described in Minnesota Statutes, Chapters 256B, 256D, and 256L. Covered services shall include, but are not limited to, the following:
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GAMC Covered Services. The HEALTH PLAN shall provide, or arrange to have provided to Enrollees comprehensive preventive, diagnostic, therapeutic and rehabilitative health care services as defined in Minnesota Statutes, Section 256D.03. Except for Section 6.2.16, these services shall be provided to the extent that this law was in effect on the effective day of this contract. These services shall include, but are not limited to, the following.
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Related to GAMC Covered Services

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Non-Covered Services The Contractor shall refer Members to Providers enrolled in the Medicaid Fee-for- Service delivery system for all Medically Necessary Services not covered by the Contractor under the MississippiCAN Program. The Contractor shall have written policies and procedures for the referral of Members for non-covered services, which shall provide for the smooth transition to Out-of-network Providers and assistance to Members in obtaining a new PCP, if appropriate. These procedures shall be applicable to the referral of Members to Out-of- network Providers, as necessary, upon Disenrollment, regardless of the reasons for Disenrollment.

  • Provision of Covered Services MCP is responsible for authorizing Medically Necessary Covered Services, including NSMHS, ensuring MCP’s Network Providers coordinate care for Members as provided in the applicable Medi-Cal Managed Care Contract, and coordinating care from other providers of carve-out programs, services, and benefits.

  • Shared Services CUPE agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis recognizing the value of benefits to the members.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”