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1.13 MEMBER means a person who is eligible and has been accepted by the Company for coverage and for whom the applicable rate has been paid for Benefits under a Health Plan. 1.14 e.tSTIC ~.AJ NG.. _P.B._OVIDE R means any hospital, physician , other health care professional, or other provider of medical 1ervices or supplies who (a) is legally qualifted to provide medical services or supplles under Washington state law; (b) has contracted with the Company, directly or through intermedll1rles, to furnish Covered Services to Me mbers as pa rt of one or rn ore of th e Companv's Provider Networks; and (c) Is eligible for reimbursem en t under a Subscriber Agreeme n t. 1.15 Mfl.!LCIPATI NG PROVIDE NETWOR~ is the colle cii\le 9rou p of hosp itals, fa cHltfes , cil ti lcs, phys:l el an s and o~r he alth ca re professionals under con tract w ith the Comp any to participate in the Compan11's network of providers identified as the Participating Provider Network. 1.16 PAVO means the entities set forth below that offer or administer a health care plan and contracts with the Company pursuant to Section 5.6 for access to one or more Provider Networks in which Medical Group participates. Payers are limited to the follow ing entities and the ir subcontractors who contract with Payor for accesa to one or more Provider Networks: subsidiaries and affiliates of the Company as set forth on Exhibit A, a Blue Cross and/or Blue Shiald Plan, a government program, a trust , and a self-funded health plan administered by the Company or one of its subsidiaries or affiliates. 1.17 ~~TBAT!VE "MANU AL is a separate reference source developed and issued by Company rar providers that indudes additional details, policies , procedures and other information that a Participating Provider will need to know in order to properly perform Its obligations under this Agreement. 1.1 B PROVID ER NETWORK means the Asll'ls Northwest Health Participating Provider Network and any other Asurls Northwest Health network of Participating Providers or lines of business that Provider agrees to participate pursuant to an addendum attached to this Agreement. 1.19 RECR EDEN TIA U NG Is a period ic process by which the Company may determine, in its sole discretion, whether to continue participating wilh a Medtcat Group. 1.20 §.LJ,P.SC IBER -AG EEf:.!l ENI Is a contract belween the Company or Payor and an individual or group in which the Company agrees to provide, indemnify for or administer health care benefits and which provides a benefit incentive if a subscriber or enrolled dependent obtains health care services from Participating Providers in the Provider Network. This Includes, but Is not limited lo, administrative services only (ASO) contracts ttle Company or Payor enters Into with employers, other out of area Blue Cross/Blue Shleld Plans and Blue Croas and Blue Shield Association services and state and federal governmental programs . This may also include Subscriber Agreements issued by the Company's branches and affiliates as set forth on Exhibit A, In accordance with Section 5.6. as well as Subscriber Agreements Issued by any successor organization of the Company . 1.21 NON -COVERED S ERV IC E. is a service or supply that is not a Covered Service for any of the following reasons : (1) the service or supply is lnvesti9ational or not Medically Necessary; or (2) the service or supply is not an avallable benefit or a Covered Service under the Subscriber Agreement for any reason. 1.22 lNVESTIGAT IQ.t:®,.: The definition provided in the Subscriber Agreement. To the extent that the Subscriber Agreement does not provide a definition of lnvestigational , the following definition shall apply : a health intervention that the Company or Payor has classified as lnvestigatlonal. The Company will review Scientific Evidence from well- designed clinical studies found in peer-reviewed medical literature, if available, and Information obtained from Medical Group regarding the health intervention to determine if Asurls MGA Agreement (Rev. O!l/2017) A18816854AA Paga 3 Df20