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Health Care Services Agreement Page 5
Health Care Services Agreement
ABC HEALTH PROVIDERs
Family Planning One 5
Member Handbook. "Member Handbook" shall mean the handbook prepared by ABCHP and
distributed to Enrollees setting forth relevant information regarding the operation of ABCHP's prepaid health
services plan.
NEW YORK CITY or CDOH-HCA. "New York City" or "CDOH-HCA" shall mean the City of New
York through the New York City Department of Health Division of Health Care Access of the Mayor of the
City of New York.
Non-Covered Services. "Non-Covered Services" shall mean those medical and other services and
benefits which are covered under the New York State Medicaid Plan but to which Enrollees are not entitled
under the applicable Member Handbook and the MEDICAID Agreement.
Participating Community Health Center. "Participating Community Health Center" shall mean a
community health center licensed under Article 28 of the New York State Public Health Law and which has
contracted with ABCHP to provide health care services to Enrollees.
Participating Hospital. "Participating Hospital" shall mean an acute care hospital which (i) is licensed
under Article 28 of the New York State Public Health Law; (ii) is accredited by the Joint Commission on
Accreditation of Healthcare Organizations ("JCAHO"); and (iii) has contracted with ABCHP to provide
inpatient, ambulatory, and related services to Enrollees.
Participating Primary Care Practitioner. "Participating Primary Care Practitioner" shall mean a
qualified physician, nurse practitioner, or team of no more than three qualified physicians/nurse practitioners
who (i) have admitting privileges at a Participating Hospital; (ii) are duly licensed in the State of New York;
and (iii) have contracted, directly or indirectly, with ABCHP to provide primary care and related services to
Enrollees.
Participating Specialty Physician. "Participating Specialty Physician" shall mean a physician who (i)
has admitting privileges at a Participating Hospital; (ii) is duly licensed in the State of New York; and (iii) has
contracted, directly or indirectly, with ABCHP to provide Specialty Services to Enrollees.
Primary Care Services. "Primary Care Services" shall mean (i) those Covered Services provided to
Enrollees that provide initial and basic primary medical care, including but not limited to those Covered
Services specifically identified as Primary Care Services on Exhibit B attached hereto; and (ii) the supervision
and coordination of the delivery of Covered Services to Enrollees.
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