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Common use of Acupuncture Clause in Contracts

Acupuncture. Acupuncture is treatment by means of inserting needles into the body to reduce pain or to induce anesthesia. It may also be used for other diagnoses as determined appropriate by your Practitioner/Provider. It is recommended that Acupuncture be part of a coordinated plan of care approved by your Practitioner/Provider. Acupuncture services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Chiropractic services are available for specific medical conditions and are not available for maintenance therapy such as routine adjustments. Chiropractic services are subject to the following: • The Practitioner/Provider determines in advance that Chiropractic treatment can be expected to result in Significant Improvement in your condition within a period of two months. • Chiropractic treatment is specifically limited to treatment by means of manual manipulation; i.e., by use of hands, and other methods of treatment approved by us including, but not limited to, ultrasound therapy. • Subluxation must be documented by Chiropractic examination and documented in the chiropractic record. We do not require Radiologic (X-ray) demonstration of Subluxation for Chiropractic treatment. Chiropractic services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Biofeedback is only Covered for treatment of Raynaud’s disease or phenomenon and urinary or fecal incontinence. As a Presbyterian Health Plan member, there will be no cost to you for anything related to COVID-19 screening, testing or medical treatment. You will not pay copays, deductibles or coinsurance for visits related to COVID-19, whether at a clinic, hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost. This benefit has one or more exclusions as specified in the Exclusions Section. Dental benefits will be provided in connection with the following conditions when deemed Medically Necessary except in an emergency situation as described in the Accidental Injury (trauma), Urgent Care, Emergency Health Care Services and Observation Services Section. Covered Services are as follows: • Accidental Injury to sound natural teeth, jawbones or surrounding tissue. Dental injury caused by chewing, biting, or Malocclusion is not considered an Accidental Injury and will not be Covered. • The correction of non-dental physiological conditions such as, but not limited to, cleft palate repair that has resulted in a severe functional impairment. • The treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Hospitalization, day surgery, Outpatient and/or anesthesia for non- Covered dental services, are Covered, if provided in a Hospital or ambulatory surgical center for dental surgery, with our approval of a Prior Authorization request. Plan benefits for these services include coverage: o For Members who exhibit physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results. o For Members for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy. o For Covered Dependent children or adolescents who are extremely uncooperative, fearful, anxious, or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity.‌ o For Members with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised. o For other procedures for which Hospitalization or general anesthesia in a Hospital or ambulatory surgical center is Medically Necessary. • Oral surgery that is Medically Necessary to treat infections or abscess of the teeth that involved the fascia or have spread beyond the dental space. • Removal of infected teeth in preparation for an Organ transplant, joint replacement surgery or radiation therapy of the head and neck. • Temporo/Craniomandibular Joint Disorders (TMJ/CMJ) o The surgical and non-surgical treatment of Temporo/Craniomandibular Joint disorders (TMJ/CMJ) such as arthroscopy, physical therapy, or the use of Orthotic Devices (TMJ splints) are subject to the same conditions, limitations, and require Prior Authorization as they apply to treatment of any other joint in the body. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education.

Appears in 2 contracts

Samples: Group Subscriber Agreement, Group Subscriber Agreement

Acupuncture. Acupuncture is treatment by means of inserting needles into the body to reduce pain or to induce anesthesia. It may also be used for other diagnoses as determined appropriate by your Practitioner/Provider. It is recommended that Acupuncture be part of a coordinated plan of care approved by your Practitioner/Provider. Acupuncture must be performed by an appropriately licensed and credentialed healthcare provider (i.e. a doctor of Oriental Medicine). Acupuncture services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Chiropractic services are available for specific medical conditions and are not available for maintenance therapy such as routine adjustments. Chiropractic services are subject to the following: • The Practitioner/Provider determines in advance that Chiropractic treatment can be expected to result in Significant Improvement in your condition within a period of two months. • Chiropractic treatment is specifically limited to treatment by means of manual manipulation; i.e., by use of hands, and other methods of treatment approved by us including, but not limited to, ultrasound therapy. • Subluxation must be documented by Chiropractic examination and documented in the chiropractic record. We do not require Radiologic (X-ray) demonstration of Subluxation for Chiropractic treatment. Chiropractic services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Biofeedback is only Covered for treatment of Raynaud’s disease or phenomenon and urinary or fecal incontinence. As a Presbyterian Health Plan memberMember, there will be no cost to you for anything related to COVID-19 screening, testing or testing, medical treatment, or vaccination. You will not pay copays, deductibles or coinsurance for visits related to COVID-19, whether at a clinic, hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost. This benefit has one or more exclusions as specified in the Exclusions Section. Dental benefits will be provided in connection with the following conditions when deemed Medically Necessary except in an emergency situation as described in the Accidental Injury (trauma), Urgent Care, Emergency Health Care Healthcare Services and Observation Services Section. Covered Services are as follows: • Accidental Injury to sound natural teeth, jawbones or surrounding tissue. Dental injury caused by chewing, biting, or Malocclusion is not considered an Accidental Injury and will not be Covered. • The correction of non-dental physiological conditions such as, but not limited to, cleft palate repair that has resulted in a severe functional impairment. • The treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Hospitalization, day surgery, Outpatient and/or anesthesia for non- Covered dental services, are Covered, if provided in a Hospital or ambulatory surgical center for dental surgery, with our approval of a Prior Authorization request. Plan benefits for these services include coverage: o For Members who exhibit physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results. o For Members for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy. allergy.‌ o For Covered Dependent children or adolescents who are extremely uncooperative, fearful, anxious, or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity.‌ morbidity. o For Members with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised. o For other procedures for which Hospitalization or general anesthesia in a Hospital or ambulatory surgical center is Medically Necessary. • Oral surgery that is Medically Necessary to treat infections or abscess of the teeth that involved the fascia or have spread beyond the dental space. • Removal of infected teeth in preparation for an Organ transplant, joint replacement surgery or radiation therapy of the head and neck. • Temporo/Craniomandibular Joint Disorders (TMJ/CMJ) o The surgical and non-surgical treatment of Temporo/Craniomandibular Joint disorders (TMJ/CMJ) such as arthroscopy, physical therapy, or the use of Orthotic Devices (TMJ splints) are subject to the same conditions, limitations, and require Prior Authorization as they apply to treatment of any other joint in the body. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education.

Appears in 1 contract

Samples: Group Subscriber Agreement

Acupuncture. Acupuncture is treatment by means of inserting needles into the body to reduce pain or to induce anesthesia. It may also be used for other diagnoses as determined appropriate by your Practitioner/Provider. These benefits cover acupuncture and acupressure treatment. Services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. There are no limits on services for habilitative or rehabilitative services. The visit limits apply to services for non-habilitative or non-rehabilitative services. It is recommended that Acupuncture be part of a coordinated plan of care approved by your Practitioner/Provider. Acupuncture services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposesmust be performed by an appropriately licensed and credentialed healthcare Provider (i.e. a doctor of Oriental Medicine). Chiropractic services are available for specific medical conditions and are not available for maintenance therapy such as routine adjustments. Chiropractic services are subject to the following: • Presbyterian will not impose a member cost share for physical rehabilitation & Chiropractic services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applicable or if a copay is applicable. The physical rehabilitation services must be performed by, or under the direction of a licensed physical therapist, occupational therapist or speech therapist. The Chiropractic services must be performed by a Chiropractic physician. • The Practitioner/Provider determines in advance that Chiropractic treatment can be expected to result in Significant Improvement in your condition within a period of two months. • Chiropractic treatment is specifically limited to treatment by means of manual manipulation; i.e., by use of hands, and other methods of treatment approved by us including, but not limited to, ultrasound therapy. • Subluxation must be documented by Chiropractic examination and documented in the chiropractic record. We do not require Radiologic (X-ray) demonstration of Subluxation for Chiropractic treatment. Chiropractic services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Biofeedback is only Covered There are no limits on services for treatment of Raynaud’s disease habilitative or phenomenon and urinary or fecal incontinencerehabilitative services. As a Presbyterian Health Plan member, there will be no cost The visit limits apply to you services for anything related to COVID-19 screening, testing or medical treatment. You will not pay copays, deductibles or coinsurance for visits related to COVID-19, whether at a clinic, hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost. This benefit has one or more exclusions as specified in the Exclusions Section. Dental benefits will be provided in connection with the following conditions when deemed Medically Necessary except in an emergency situation as described in the Accidental Injury (trauma), Urgent Care, Emergency Health Care Services and Observation Services Section. Covered Services are as follows: • Accidental Injury to sound natural teeth, jawbones or surrounding tissue. Dental injury caused by chewing, biting, or Malocclusion is not considered an Accidental Injury and will not be Covered. • The correction of non-dental physiological conditions such as, but not limited to, cleft palate repair that has resulted in a severe functional impairment. • The treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Hospitalization, day surgery, Outpatient and/or anesthesia for non- Covered dental services, are Covered, if provided in a Hospital habilitative or ambulatory surgical center for dental surgery, with our approval of a Prior Authorization request. Plan benefits for these services include coverage: o For Members who exhibit physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results. o For Members for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy. o For Covered Dependent children or adolescents who are extremely uncooperative, fearful, anxious, or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity.‌ o For Members with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised. o For other procedures for which Hospitalization or general anesthesia in a Hospital or ambulatory surgical center is Medically Necessary. • Oral surgery that is Medically Necessary to treat infections or abscess of the teeth that involved the fascia or have spread beyond the dental space. • Removal of infected teeth in preparation for an Organ transplant, joint replacement surgery or radiation therapy of the head and neck. • Temporo/Craniomandibular Joint Disorders (TMJ/CMJ) o The surgical and non-surgical treatment of Temporo/Craniomandibular Joint disorders (TMJ/CMJ) such as arthroscopy, physical therapy, or the use of Orthotic Devices (TMJ splints) are subject to the same conditions, limitations, and require Prior Authorization as they apply to treatment of any other joint in the body. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and educationrehabilitative services.

Appears in 1 contract

Samples: Subscriber Agreement

Acupuncture. Acupuncture is treatment by means of inserting needles into the body to reduce pain or to induce anesthesia. It may also be used for other diagnoses as determined appropriate by your Practitioner/Provider. It is recommended that Acupuncture be part of a coordinated plan of care approved by your Practitioner/Provider. Acupuncture must be performed by an appropriately licensed and credentialed healthcare provider (i.e. a doctor of Oriental Medicine). Acupuncture services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. Chiropractic services are available for specific medical conditions and are not available for maintenance therapy such as routine adjustments. Chiropractic services are subject to the following: • The Practitioner/Provider determines in advance that Chiropractic treatment can be expected to result in Significant Improvement in your condition within a period of two months. • Chiropractic treatment is specifically limited to treatment by means of manual manipulation; i.e., by use of hands, and other methods of treatment approved by us including, but not limited to, ultrasound therapy. • Subluxation must be documented by Chiropractic examination and documented in the chiropractic record. We do not require Radiologic (X-ray) demonstration of Subluxation for Chiropractic treatment. Chiropractic services are limited to 20 visits per Contract Year unless for rehabilitative or habilitative purposes. purposes.‌‌‌ Biofeedback is only Covered for treatment of Raynaud’s disease or phenomenon and urinary or fecal incontinence. As a Presbyterian Health Plan memberMember, there will be no cost to you for anything related to COVID-19 screening, testing or testing, medical treatment, or vaccination. You will not pay copays, deductibles or coinsurance for visits related to COVID-19, whether at a clinic, hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost. This benefit has one or more exclusions as specified in the Exclusions Section. Dental benefits will be provided in connection with the following conditions when deemed Medically Necessary except in an emergency situation as described in the Accidental Injury (trauma), Urgent Care, Emergency Health Care Healthcare Services and Observation Services Section. Covered Services are as follows: • Accidental Injury to sound natural teeth, jawbones or surrounding tissue. Dental injury caused by chewing, biting, or Malocclusion is not considered an Accidental Injury and will not be Covered. • The correction of non-dental physiological conditions such as, but not limited to, cleft palate repair that has resulted in a severe functional impairment. • The treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Hospitalization, day surgery, Outpatient and/or anesthesia for non- Covered dental services, are Covered, if provided in a Hospital or ambulatory surgical center for dental surgery, with our approval of a Prior Authorization request. Plan benefits for these services include coverage: o For Members who exhibit physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results. results.‌‌ o For Members for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy. o For Covered Dependent children or adolescents who are extremely uncooperative, fearful, anxious, or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity.‌ morbidity. o For Members with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised. o For other procedures for which Hospitalization or general anesthesia in a Hospital or ambulatory surgical center is Medically Necessary. • Oral surgery that is Medically Necessary to treat infections or abscess of the teeth that involved the fascia or have spread beyond the dental space. • Removal of infected teeth in preparation for an Organ transplant, joint replacement surgery or radiation therapy of the head and neck. • Temporo/Craniomandibular Joint Disorders (TMJ/CMJ) o The surgical and non-surgical treatment of Temporo/Craniomandibular Joint disorders (TMJ/CMJ) such as arthroscopy, physical therapy, or the use of Orthotic Devices (TMJ splints) are subject to the same conditions, limitations, and require Prior Authorization as they apply to treatment of any other joint in the body. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education.

Appears in 1 contract

Samples: Group Subscriber Agreement