CARE PHYSICIAN CASE Sample Clauses

CARE PHYSICIAN CASE. PATIENT At the time of determining Medi-Cal eligibility, Plan will request each person determined to be a Case Managed Member to select among those Primary Care Physicians contracting with Plan who are accepting Members. If no selection is made, Plan shall assign Members to a Primary Care Physician in a systematic manner in accordance with Plan policies. ‘Plan will notify all Linked Members the Member’s Care Physician is terminated or terminates SO that Linked Members may choose a new Primary Care Physician as soon as practicable. The Member’s Primary Care Physician shall be the sole source of primary medical . contact and advice for the Member and shall provide or authorize the referral for all health care services, except for Emergency Services, Self-Referral Services and excluded Services. The Member’s Primary Care Physician shall be responsible for the Member’s Case Management until the time such Member’s Primary Care Physician is changed in accordance with Plan’s policies. The Member’s Primary Care Physician shall have the right to refer the Member to any Referral Physician or Allied Health Service Provider. The Provider to whom the Primary Care Physician has delegated the authority to proceed with treatment or the use of resources, shall be responsible for monitoring all medical advice and services performed or prescribed such Provider for the Member. Such Providers shall furnish a complete report in a timely manner to each Primary Care Physician of all services rendered to the Primary Care Physician’s Linked Members. 01 71 C E N T R A L C O A S T A L L I A N C E F O R H E A L T H Each individual primary care physician shall serve at least one hundred (100) Members, unless excepted by Plan. Each Primary Care Physician may designate the maximum number of Members such physician shall serve; provided, however, there shall be at least one FTE primary care physician for every two thousand (2,000) Members. In addition, each individual primary care physician shall maintain an active patient load of no more than two thousand (2,000). Active patients are those patients seen one or more times in a twelve (12) month period. A Primary Care Physician may request that only current patients be included as Linked Members. Otherwise, the Primary Care Physician agrees to accept as patients all Members who have selected or been assigned to the Primary Care Physician, up to the maximum number of Members designated by the Primary Care Physician, without regard to the hea...
Sample 1
AutoNDA by SimpleDocs

Related to CARE PHYSICIAN CASE

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • Health Care Operations Health Care Operations shall have the meaning set out in its definition at 45 C.F.R. § 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.

  • Medical Exams 18.1: The Sheriff's Department may require a physical and/or psychological exam by a doctor, at the Employer's expense, to determine the employee's ability to perform his/her regular duties, if deemed appropriate. The employee may obtain a second opinion, at the employee's expense, and in the event there is a dispute between the Employer's doctor and the employee's doctor, both of these doctors shall select a third doctor, whose decision shall be final and binding on the parties. The expense for the third doctor's opinion shall be split 50-50 by the Employer and the employee if not covered by the employee's insurance.

  • Dental Care Plan The Welfare Plan will include a Dental Care Plan which will reimburse members for expenses incurred in respect of the coverages summarized in Appendix "1". The Plan will not duplicate benefits provided now or which may be provided in the future by any government program.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for one hundred thirty days (130) workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Classified Personnel Assignments Branch.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Health Care Committee A Health Insurance Committee shall be established and maintained with at least three (3) representatives appointed by the Association and three (3) representatives appointed by the Superintendent. The purpose of the Committee shall be to make recommendations designed to optimize the quality of health care available to District employees and improve cost effectiveness of the health insurance program. Committee members shall review data, work with the District insurance consultant, collaborate on making recommendations for changes in plan design, review bids by insurance companies, and ultimately consider recommending plan changes to their respective constituencies. The Committee is not empowered to unilaterally make changes in health care benefits without ratification by the Association and approval by the Board. The creation of the Committee does not diminish or in any way reduce the Board’s and Association’s rights or responsibilities.

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Vision Care Plan The County agrees to provide a Vision Care Plan for all employees and dependents. The Plan will be the Vision Service Plan - Plan A with benefits at 12/12/24 month intervals and with twenty dollar ($20.00) deductible for examinations and twenty dollar ($20.00) deductible for materials. The County will fully pay the monthly premium for the employee and dependents and pick up inflationary costs during the term of the Agreement.

  • Hospitals a. In every Hospital:

Time is Money Join Law Insider Premium to draft better contracts faster.