Common use of Material Modification of Provider Clause in Contracts

Material Modification of Provider. Network means 1) a change that would result in an Enrollee having only three remaining choices of a Primary Care Provider within thirty (30) miles or thirty (30) minutes; or 2) a change that results in the discontinuation of a Primary Care Provider who is responsible for Primary Care for one third (1/3) or more of the Enrollees in the applicable area (the same area from which the affected Enrollee chose their Primary Care Provider or sole source Provider, prior to the Material Modification); or 3) a change that involves a termination of a sole source Provider where the termination is for cause. Such changes include both Medicare and Medicaid Providers, and pharmacy benefit managers as applicable. For purposes of this section, termination of a Provider for cause does not include the inability to reach agreement on contract terms.

Material Modification of Provider. Network means 1) a change that would result in an Enrollee having only three remaining choices of a Primary Care Provider within thirty (30) miles or thirty (30) minutes; or 2) a change that which results in the discontinuation of a Primary Care Provider who is responsible for Primary Care for one third (1/3) or more of the Enrollees in the applicable area (the same area from which the affected Enrollee chose their Primary Care Provider or sole source Provider, prior to the Material Modification); or 3) a change that which involves a termination of a sole source Provider where the termination is for cause. Such ; and 4) such changes include both Medicare and Medicaid Providers, Providers and pharmacy benefit managers as applicablemanagers. For purposes of this section, termination of a Provider for cause does not include the inability to reach agreement on contract terms.