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First Choice Health", First Choice Health Network Preferred Provider/Group Agreement On:, llr ,tr '.;~r,,., r. JIJ) L w,m i~ 5if~}: !iL •,; I ,l1.Jt S}.:Clr., WA. J!l I:· 1 a:o 467 ~-2f1 Fa:;· 2~6 !;61 &XO 1~'1.'',1/.l•~llll.CC·nl This Agreement is entered into between First Choice Health Network, Inc., a Washington corporation , ("FCHN , Inc.") and First Choice He alt h Network of Oregon , lnc.1 an Oreg on corporati on , ("FCHN, Oreg on ") on one hand , and Kittitas Cquhly Public Health Dep artment {hereinafter ''Provi der~) on the oth er hand . The effecti ve date of this Agre em ent is lhe-zf'1:lay or f'(llf:J ~ o I f( {"Effective Date"), FC HN , Inc, and FCH N, Ore gon is collectively referred to herein a·s "FCHN". In consideration of the mutual promises and covenants set forth herein, FCHN and Provider agree as follows: 1. DEFINITIONS 1.1 Agreement means this Preferred Provider Agreement for health services between FCHN and the Provider/Provider Group and any Amendments , Schedules and Exhibits hereto. 1.2 Benefit Plan means a program offered by or administered by a Payor for the payment of Covered Services provided to an eligible Participant. Benefit Plans may be insured or self-insured, and shall not indude discount medical plan programs defined as including, but not limited to, programs that do not include an element of insurance risk and/or prepaid medical services. 1.3 Clean Claim means a claim that has no defect or impropriety, including any lack of any required substantiating documentation or particular circumstances requiring special treatment that prevents timely payments from being made on the claim. 1.4 Coinsurance means a cost-sharing obligation that requires the Participants to pay a percentage of the cost of specified Covered Services. 1.5 Co-payment means the amount that a Participant is responsible to pay under a Benefit Plan at the time of serv ice. 1.6 Covered Services means those specified Medically Necessary health care benefits and services which a Participant is eligible to receive under the Participant's Benefit Plan. Covered Services is further defined as services for which a Provider is entitled to receive payment from a Payor pursuant to the terms of this Agreement and for which benefits under the Participant's Benefit Plan have not been exhausted. 1.7 Deductible means the amount a Participant must pay for Covered Services each calendar or contract year before a Payor commences payment for Covered Services as defined under the applicable Benefit Plan. 1.8 Emergency Medical Condition means the emergent and acute onset of a symptom or symptoms, including severe pain, that would lead a prudent layperson , acting reasonably to believe that a health condition exists that requires immediate medical attention, if failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the Participant's health in serious jeopardy. 1.9 Medical Director means the officer of FCHN, the Payor, or other party who is in charge of the applicable Medical Management Program for the Participant. FCHN-PRO-042016