Common use of Timely Access to Care Clause in Contracts

Timely Access to Care. We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. ● ▇▇▇▇▇▇ care appointments not requiring prior authorization may be obtained within forty-eight (48) hours of the request for an appointment. ● ▇▇▇▇▇▇ care appointments requiring prior authorization may be obtained within ninety- six (96) hours of the request for an appointment. ● Non-urgent appointments for primary care may be obtained within ten (10) business days of the request for an appointment. ● Non-urgent appointments with specialist physicians may be obtained within fifteen (15) business days of the request for appointment. ● Non-urgent appointments with a non-physician mental health care provider may be obtained within ten (10) business days of the request for an appointment. ● Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health conditions may be obtained within fifteen (15) business days of the request for an appointment. ● Telephone triage or screening service wait time shall not exceed thirty (30) minutes. The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with the professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the Members. Preventive care services, and periodic follow up care, including but not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. ▇▇▇▇▇ provides interpretation services, as described in the “Introduction” section titled “How to Get Language Assistance.” Please see this section for complete instructions and phone numbers to request assistance.

Timely Access to Care. We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. ● • ▇▇▇▇▇▇ care appointments not requiring prior authorization may be obtained within forty-eight (48) 48 hours of the request for an appointment. ● • ▇▇▇▇▇▇ care appointments requiring prior authorization may be obtained within ninety- six (96) 96 hours of the request for an appointment. ● • Non-urgent appointments for primary care may be obtained within ten (10) 10 business days of the request for an appointment. ● • Non-urgent appointments with specialist physicians may be obtained within fifteen (15) 15 business days of the request for appointment. ● • Non-urgent appointments with a non-physician mental health care provider may be obtained within ten (10) business days of the request for an appointment. ● • Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health conditions may be obtained within fifteen (15) 15 business days of the request for an appointment. ● • Telephone triage or screening service wait time shall not exceed thirty (30) 30 minutes. The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with the professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the MembersMember. Preventive care services, and periodic follow up care, including but not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. ▇▇▇▇▇ provides interpretation services, as described in the “Introduction” section titled “How to Get Language Assistance.” Please see this section for complete instructions and phone numbers to request assistance.