How Covered Services Work Sample Clauses
How Covered Services Work
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 MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following: 1. All non-medically necessary services; 2. Sterilization of a mentally incompetent or institutionalized individual; 3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition; 4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility5 and for the reversal of sterilization;
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.
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.”
Shift Work (1) Except as varied by this Clause, all other aspects of Section 4 of the Agreement shall apply to the working of shift work. (2) The Company has the right to direct Employees to work shift work as required and the Employees shall work the shift work as directed. Shift work will be worked and paid for in accordance with this subclause. (3) Shift work is deemed to be any arrangement of Project Working Hours where the majority of the Ordinary Hours are worked outside of the spread of Ordinary Hours defined at clause 16 - Hours of Work of this Agreement and when Employees are working as such. (4) Ordinary Hours for shift Employees will comprise thirty-six (36) hours per week averaged over a defined work cycle and will not commence before 5.00pm on Sunday night. Such Ordinary Hours are the specified hours under each shift Employee's terms of employment by reference to which annual leave and personal/carer's leave accrue. (5) Prior to the commencement of shift work, the Company shall seek the agreement of the Employees involved. Failing agreement, the Company will provide to the Employees concerned one (1) week's notice of the commencement of shift work and the starting and finishing times of Ordinary Hours of the shifts. (6) Where less than five (5) consecutive shifts are worked then Employees shall be paid at overtime rates in lieu of the shift loading prescribed at subclause (7) of this clause. The consecutive nature of shifts will not be deemed to be broken if work is not carried out on a Saturday, Sunday, RDO or on any public holiday. (7) A shift Employee shall receive a flat loading of twenty-five (25) percent of their Ordinary Hourly Rate for each hour worked. (8) Employees working night shift shall be entitled to stop work for a half-hour without deduction of pay for the purpose of taking a meal break. (9) The Company may stagger the times for Employees to take meal breaks to meet operational requirements. (10) The Company shall structure the Project Working Hours for Employees working night shift to include one (1) half-hour rest break to be taken without deduction of pay by Employees working the Project Working Hours on any night shift.