Orthotics Benefits Sample Clauses

Orthotics Benefits. Benefits are provided for orthotic appliances and devices for maintaining normal Activities of Daily Living only. Benefits include:
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Orthotics Benefits. Benefits are provided for orthotic appliances, including:  Shoes only when permanently attached to such applianc- es;  Special footwear required for foot disfigurement which includes, but is not limited to, foot disfigurement from cerebral palsy, arthritis, polio, xxxxx bifida, and foot dis- figurement caused by accident or developmental disabil- ity;  Medically Necessary knee braces for post-operative re- habilitation following ligament surgery, instability due to injury, and to reduce pain and instability for patients with osteo-arthritis;  Medically Necessary functional foot orthoses that are custom made rigid inserts for shoes, ordered by a physi- cian or podiatrist, and used to treat mechanical problems of the foot, ankle or leg by preventing abnormal motion and positioning when improvement has not occurred with a trial of strapping or an over-the-counter stabilizing device;  Initial fitting and replacement after the expected life of the orthosis is covered. Benefits are provided for orthotic devices for maintaining normal Activities of Daily Living only. No benefits are pro- vided for orthotic devices such as knee braces intended to provide additional support for recreational or sports activities or for orthopedic shoes and other supportive devices for the feet. No benefits are provided for backup or alternate items. Benefits are limited to a per Member, per Calendar Year maximum as shown in the Summary of Benefits. This max- imum does not apply to Services covered under the Diabetes Care benefit.
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Orthotics Benefits. Benefits are provided for orthotic appliances and devices for maintaining normal Activities of Daily Living only. Benefits include: Outpatient X-ray, Pathology and Laboratory Benefits Benefits are provided for X-ray services, diagnos- tic testing, clinical pathology, and laboratory ser- vices when provided to diagnose illness or injury. Benefits are provided for genetic testing for at-risk Members according to Blue Shield medical policy and for prenatal genetic screening and diagnostic services as follows:
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Orthotics Benefits. Medically necessary Orthoses for Activities of Daily Living are covered, including the following:
Sample 1
Orthotics Benefits. 44 Outpatient or Out-of-Hospital X-Ray, Pathology, and/or Laboratory Benefits 44 Outpatient Rehabilitation Benefits 45 Outpatient Prescription Drug Benefits 45 PKU Related Formulas and Special Food Products Benefits 49 Podiatric Benefits 49 Pregnancy Benefits 49 Preventive Health Benefits 49 Professional (Physician) Benefits 51 Prosthetic Appliance Benefits 52 Radiological and Nuclear Imaging Benefits 52 Skilled Nursing Facility Benefits 53 Speech Therapy Benefits 53 Transplant Benefits 53 PRINCIPAL LIMITATIONS, EXCEPTIONS, EXCLUSIONS, AND REDUCTIONS 54 General Exclusions and Limitations 54 Medical Necessity Exclusion 57 Pre-Existing Conditions 57 Limitations for Duplicate Coverage 58 Exception for other Coverage 58 Claims Review 58 Reductions - Acts of Third Parties 59 GENERAL PROVISIONS 59 Independent Contractors 59 Non-Assignability 59 Plan Interpretation 60 Confidentiality of Personal and Health Information 60 Access to Information 60 Entire Agreement: Changes 60 Legal Process 60 Organ and Tissue Donation 60 Choice of Providers 60 Endorsements and Appendices 61 Grace Period 61 Notices 61 Commencement or Termination of Coverage 61 Identification Cards 61 Statutory Requirements 61 Notice 61 Public Policy Participating Procedure 61 Procedure 62 CUSTOMER SERVICE 62 For all Services other than Mental Health 62 For all Mental Health Services 62 GRIEVANCE PROCESS 63 For all Services other than Mental Health 63 For all Mental Health Services 63 External Independent Medical Review 63 Department of Managed Health Care Review 64 DEFINITIONS 64 Plan Provider Definitions 64 All Other Definitions 66 NOTICE OF THE AVAILABILITY OF LANGUAGE ASSISTANCE SERVICES 71 PPO Summary of Benefits Note: The Summary of Benefits represents only a brief description of the Benefits. Please read this Agreement carefully for a com- plete description of provisions, benefits, exclusions, and other important information pertaining to this Plan. Note: For Benefits that have a visit maximum, all visits count toward the visit maximum, regardless of whether the Calendar Year Deductible has been satisfied, or you have reached the Calendar Year Out-of Pocket Maximum Responsibility.
Sample 1

Related to Orthotics Benefits

  • Health Benefits The method for determining the Employer bi-weekly contributions to the cost of employee health insurance programs under the Federal Employees Health Benefits Program (FEHBP) will be as follows:

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Program Benefits Under the Probation Status, the Participating Contractor will be eligible for all contractor incentives, its customers will have access to financing offered through the Program, and income- eligible households will be eligible to receive Program incentives.

  • WELFARE BENEFITS Subject to the terms and conditions of this Agreement, for a period of twelve (12) months following the date of Involuntary Termination (and an additional twelve (12) months if the Executive provides consulting services under Section 14(f) hereof), the Executive and his dependents shall be provided with life, disability, accident and group medical benefits which are substantially similar to those provided to the Executive and his dependents immediately prior to the date of Involuntary Termination or the Change in Control Date, whichever is more favorable to the Executive. Without limiting the generality of the foregoing, the continuing benefits described in the preceding sentence shall be provided on substantially the same terms and conditions and at the same cost to the Executive as in effect immediately prior to the date of Involuntary Termination or the Change in Control Date, whichever is more favorable to the Executive. Such benefits shall be provided in a manner that complies with Treasury Regulation Section 1.409A-1(a)(5). Notwithstanding the foregoing, if Sempra Energy determines in its sole discretion that the portion of the foregoing continuing benefits that constitute group medical benefits cannot be provided without potentially violating applicable law (including, without limitation, Section 2716 of the Public Health Service Act) or that the provision of such group medical benefits under this Agreement would subject Sempra Energy or any of its Affiliates to a material tax or penalty, (i) the Executive shall be provided, in lieu thereof, with a taxable monthly payment in an amount equal to the monthly premium that the Executive would be required to pay to continue the Executive’s and his covered dependents’ group medical benefit coverages under COBRA as then in effect (which amount shall be based on the premiums for the first month of COBRA coverage) or (ii) Sempra Energy shall have the authority to amend the Agreement to the limited extent reasonably necessary to avoid such violation of law or tax or penalty and shall use all reasonable efforts to provide the Executive with a comparable benefit that does not violate applicable law or subject Sempra Energy or any of its Affiliates to such tax or penalty.

  • HEALTH & WELFARE BENEFITS Executive shall be eligible to participate in all health and welfare benefits provided generally to other employees of the Company.

  • Retiree Health Benefits 1. There is currently in effect a retiree health benefit program for retired members of LACERS under LAAC Division 4, Chapter 11. All covered employees who are members of LACERS, regardless of retirement tier, shall contribute to LACERS four percent (4%) of their pre-tax compensation earnable toward vested retiree health benefits as provided by this program. The retiree health benefit available under this program is a vested benefit for all covered employees who make this contribution, including employees enrolled in LACERS Tier 3.

  • Dental Benefits The County offers dental and orthodontic benefits to full and part-time regular employees and their eligible dependent(s). Benefit provisions, co­ payments and deductibles are outlined in the Evidence of Coverage. The employee contribution is $13 per pay period ($28.26 per month). The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.

  • Sponsorship Benefits 3.1 INREV agrees to grant the Sponsor the above chosen and described sponsorship benefits.

  • HEALTH AND WELFARE BENEFITS (Article 17 applies to full-time nurses only)

  • Sick Benefits 15.01 Eligible employees will receive Short Term Disability Benefits in accordance with the terms and conditions outlined in the STD Plan Text, a copy of which has been supplied to the Union. The STD plan forms part of this Collective Agreement.

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