Aetna Health Inc. - 071116
Board of Commissioners
Aetna Health Inc. - 071116
1/27/2017 1:56:38 PM
1/27/2017 1:54:38 PM
Physicians Group for Provider Services
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PItOVIDER AGREEMENT <br />PRODUCT PARTICIPATION AND SIGNATURE SHEET <br />The Provider Agreement consists of the following parts: <br />i) This Product Participation and Signature Sheet (the "Signature Sheet") which lists the types of <br />Products that Provider will participate in as of the Effective Date; <br />ii) General Terms and Conditions applicable to Provider's network participation; <br />iii) One or more State Compliance Addenda that contain state -specific requirennents applicable to certain <br />types of Products and/or health care provider -types; and <br />iv) One or more Product Addenda that set forth additional terms of Provider's participation in specific <br />Products; <br />v) One or more service and rate, reimbursement or compensation schedules (the "Service and Rate <br />Schedules") that contain the rates and related provisions for specific Products. <br />The Signature Sheet, General Terms and Conditions, State Conapliar►re Addenda, Product Addenda and <br />Service and Rate Schedules, together with any related exhibits, addenda and appendices, are collectively referred <br />to throughout the documents as the "Agreement." In dne event of a conflict in language between thtc General <br />Terms and Conditions and a Product Addendum or Service and hate Schedule, tlae tenlas of tine applicable <br />Product Addendum and corresponding Service and Rate Schedule will prevail. In the event of conflict between <br />all applicable State Compliance Addendum and any other part of the Agt'ecnnent, tine terms of the State <br />Compliance Addendum will prevail, but only with respect to tlae particular lute e,f busincss (e.g., fully insured <br />HMO) or Product. Various Products may be offered by separate Cot ipany Affiliates and each such Affiliate is <br />deemed to be a Party to the Agreement. <br />By executing this Signature Shcet, Provider agrees to participate in tite Product categories identified below with a <br />check mark. Each Product category is described more fully in tite applicable'Product Addendum. New types and <br />categories of Products may be added and participation in specific. Productsmay be added or terraninatcd in <br />accordance with tine terms of the Agreement: <br />I ✓ I Commercial Health <br />Medicare <br />Institutes of Excellence0 (I OE) Transplant Network (subject to separate approval by Company) <br />Medical Rental Network <br />Workers' Compensation Network <br />Auto Network <br />Other <br />Provider Agreement (2016) Page I o1-21 V.2.0.04.16 <br />
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