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it is Investigational. A health intervention not meeting all of the following criteria, is, in the Company's judgment, Investigational: Q The Scientific Evidence must permit conclusions concerning the effect of the Health Intervention on health outcomes, which include the disease process, Injury or Illness, length of life, ability to function and quality of life. The health intervention must improve net health outcome. • The Scientific Evidence must show that the health intervention is as beneficial as any established alternatives. • The improvement must be attainable outside the laboratory or clinical research setting. For purposes of this definition, Scientific Evidence means scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff; or findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes. However, Scientific Evidence shall not include published peer-reviewed literature sponsored to a significant extent by a pharmaceutical manufacturing company or medical device manufacturer or a single study without other supportable studies. II. PROVISION OF MEDICAL SERVICES 2.1 MEDICALLY NECESSARY SERVICES — Medical Group will provide Medically Necessary Services to Members in accordance with the terms of this Agreement. Company will only bear financial responsibility for Medically Necessary, Covered Services furnished to Members by Medical Group. Company will not make retroactive denials of Covered Services that were pre -certified or concurrently certified as medically necessary unless the certification was based upon a material misrepresentation by Medical Group. 2.2 COVERED SERVICES — Company will define the Covered Services for the Health Plans for which Medical Group has agreed to provide services. 2.3 STANDARDS OF CARE — The Medical Group shall provide services to Members in accordance with generally accepted professional standards of care and medical and billing practices in the community. Medical Group agrees to furnish Covered Services to Members without regard to the Member's enrollment in the Health Plan as a private purchaser or as a participant in publicly funded programs. 2.4 RELATIONSHIP WITH MEMBERS — Company will not be liable for nor will it exercise control or direction over the methods or professional judgments relied upon by Medical Group and Medical Group's Providers, employees or representatives in providing services pursuant to this Agreement. Medical Group will be solely responsible for supervising and controlling Medical Group's employees to assure that such services are provided in a manner that complies with generally accepted standards of care. Medical Group Provider will be responsible for clinical decisions regarding the medical care and treatment of Members. Nothing in this Agreement limits Medical Group Provider's right to communicate freely with Members, including the right to inform Members that Medical Group Provider believes services are appropriate or necessary, even if Company has determined the services are not Covered Services. 2.5 NONDISCRIMINATION - Medical Group will provide the Covered Services contemplated herein without regard to the race, age, sex, religion, creed, color, national origin or ancestry of any Member. During the term of this Agreement, Medical Group will not unlawfully discriminate against any employee or applicant for employment because of race, religion, color, national origin, ancestry, physical handicap, health status, marital Asuris MGA Agreement (Rev. 05/2017) Al8816854AA Page 4 of 20