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support of a health eare program for an individual or group of individuals, and whioh may include access to one or
<br />more of Company's prrovider networks or vendor arrangements, excopt those excluded by Health Plan,
<br />1.8, "Covered Perso-1t''means any individual entitled to receive Covered Services pursuant to the terms
<br />of a Coverage Agreement.
<br />1.9. "Coverecl-Services" means those services and items for which benefits are available and payable
<br />under the applicable Coverage Agree.ment and which are detendned, if applicable, to be Medically Necessary under
<br />the applicable Coverage Agreement.
<br />1.10. "IlealthlPlgq" means either CCC or CCW with respect to each Product covered by this Agreemen!
<br />as specified in accordance with Schedule B to this Agreement or the applicable Product Attachment.
<br />I .l I . "Medigaly-Neoclsary,n or "]4edigal-\legessi!y'' shall have the meaning defined in the applicable
<br />Coverage Agreement and applicable Regulatory Requirements.
<br />1..12. "Partic.ipating Providef' mears, with respeot to a particulm Produc! any physiciarq hospital,
<br />ancillary, or other health care provider that has contlacted, directly or indirectl5 with Health Plan to provide Covered
<br />Services to Covered Persons, that has been approved for participation by Company, and that is designated by
<br />Company as a "participating provider" in such Product.
<br />1.13. ('!gpl" rneans the entity (including Company where applicable) that bears direct financial
<br />responsibility for paying from its own funds, without reimbursement from another entity, the cost of Covered Services
<br />rendsred to Covored Per$ons uncler a Coverage Agreement and, if such entity is not Company, such elrtity contracts,
<br />directly or indirectly, with Company for tho provision of oertain administrative or other services with respect to such
<br />Coverage Agreement.
<br />t'L4. "Pgg-eQ!ffa4" means the contraet with a Payor, pursuant to which Company furnishes
<br />administrative servic,es or other services in zupport of the Coverage Agreements entered into, issued or agreed to by
<br />a Payor, which services may include access to one ot more of Company's provider netwarks or vendor arrangements,
<br />except those excluded by Health Plan. The term'?ayor Contract" includes Company's or other Payor's contract
<br />with a governmental authority (also referred to herein as a "Goverrunental Contract') irnder which Company orPayor
<br />affanges fur the provision of Covered Seryices to Covered Persons.
<br />1.15' 3'pssducf'means any program or health beneflt arrangement designated as a "producf'by Health
<br />Plan (e.g., Health Plan Product, Medicaid Product, PPO Procluct, Payor-specific Product, etc.) that is now or hereafler
<br />offered by or available from or through Company (and includes the Coverage Agreements that access, or are issued
<br />or entered into in connection with such product, except those excluded by Health Plan),
<br />1.16. "Plqdugt4.ttaghlqent" means anAttachment setting forth requirements, terms and conditions specific
<br />or applicable to one or more Products, including certain provisions that must be included in a provider agreement
<br />rrnder the Regulatory Requirements, which may be alternativas to, or in adtlition to, the requirements, terms and
<br />conditions set forth in this Agreement.
<br />1,17. "Regulato.f,v ReErirements" means all applicable federal and state statutes, regulations, regulatory
<br />guidance, judicial or administrative rulings, requirerrents of Governmental Contracts and standards and requirerrents
<br />of any accrediting or certifying organization, including, but not limited to, the requirements set forth in a Product
<br />Attachment.
<br />1.18. (6state:' is defined as the State of Washington.
<br />PPA WA - Ifittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page2 of2A
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