Common use of REASONABLE EFFORTS AND ASSURANCES Clause in Contracts

REASONABLE EFFORTS AND ASSURANCES. The Contractor must make reasonable efforts to honor a Member's choice of Providers among Network Providers as long as: i. The PH-MCO's agreement with the Network Provider covers the services required by the Member; and ii. The Contractor has not determined that the Member's choice is clinically inappropriate. The Contractor must provide the Department adequate assurances that the Contractor, with respect to the HC-L/C zone, has the capacity to serve the expected enrollment in the HC-L/C zone by providing assurances that the Contractor offers the full scope of covered services as set forth in this Agreement and access to preventive and primary care services and maintains a sufficient number, mix and geographic distribution of Providers and services in accordance with the standards set forth in Section V.S of this Agreement, Provider Network/Services Access.

REASONABLE EFFORTS AND ASSURANCES. The Contractor must make reasonable efforts to honor a Member's choice of Providers among Network Providers as long as: i. The PH-MCO's agreement with the Network Provider covers the services required by the Member; and ii. The Contractor has not determined that the Member's choice is clinically inappropriate. The Contractor must provide the Department adequate assurances that the Contractor, with respect to the HC-L/C HealthChoices zone, has the capacity to serve the expected enrollment in the HC-L/C HealthChoices zone by providing assurances that the Contractor offers the full scope of covered services as set forth in this Agreement and access to preventive and primary care services and maintains a sufficient number, mix and geographic distribution of Providers and services in accordance with the standards set forth in Section V.S of this Agreement, Provider Network/Services Access.