Reso 2010-1529 - Laserfiche WebLink

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AvMed, Inc. d/b/a AvMed HEALTH PLANS ') GROUP MEDICAL AND HOSPITAL SERVICE CONTRACT IN CONSIDERATION of the payment of monthly prepayment subscription amounts as provided herein and of mutual promises and benefits hereinafter described, AvMed, Inc., a Florida corporation, d/b/a AvMed Health Plans, (hereinafter referred to as 'AvMed'), and (hereinafter referred to as 'Subscribing Group') agree as follows: I. GENERAL The Subscribing Group engages AvMed, on behalf of the group health plan described herein (the 'Plan'), to arrange for the provision of Medical Services or benefits which are Medically Necessary for the diagnosis and treatment of Members of the Subscribing Group throtlgh a network of contracted independent physicians and Hospitals and other independent health care providers who are not agents or employees of AvMed. See Section 15.04). AvMed, in arranging for the delivery of Medical Services or benefits, does not directly provide these Medical Services or benefits. AvMed arranges for the provision of said services in accordance with the covenants and conditions contained in this Contract. AvMed shall rely upon the statements of the Subscriber in his application in providing coverage and benefits hereunder. This Contract is not intended to and does not cover or provide any Medical Services or benefits that are not Medically Necessary for the diagnosis and treatment of the Member. The determination as to which services are Medically Necessary shall be rnade by AvMed subject to the terms and conditions of this Contract. AvMed reserves the right to make changes in coverage criteria for covered products and services. Coverage criteria are medical and pharmaceutical protocols used to determine payment of products and services and are based on independent clinical practice guidelines and standards of care established by government agencies and medicalJphannaceutical societies. ) The Medical and Hospital Services covered by this Contract shaH be provided without regard to the race, color, religion, physical handicap, or national origin of the Mernber in the diagnosis and treatment of patients; in the use of equipment and other facilities; or in the assignment of personnel to provide services, pursuant to the provisions of Title VI of the Civil Rights Act of 1964, as amended, and the Americans with Disabilities Act of 1990. II. INTERPRETATION In order to provide the advantages of Hospital and medical facilities and of the Participating Providers, AvMed operates on a direct service rather than indemnity basis. The interpretation of this Contract shaH be guided by the direct service nature of AvMed's program and the definitions and other provisions contained herein.. I A V -0 I 00-2009 MP-5319 (10/09)