After‐Hours Care. Your Participating IPA/Participating Medical Group has systems in place to main tain a twenty‐four (24) hour answering service and ensure that each Primary Care Physician or Woman's Principal Health Care Provider provides a twenty‐four
After‐Hours Care. In the event medical treatment is required for a work related injury after the office hours of the designated clinics or on a weekend, the employee should go to the Emergency Room at Centennial Healthcare Plaza, 00000 Xxxx Xxxxxxxx Xxxx, Xxxxxxxxxx, XX (303-699-3000). • If an employee wishes to be treated by a physician other than those approved, they do so at their own expense. Lost Time • Any time off from work due to a work related injury must be authorized by a designated physician. • In accordance with the Colorado Workers’ Compensation Statute, an injured employee must be absent from work for three days before Workers’ Compensation Wage Benefits begin. Employees may use up to three days of their accumulated sick leave for the first three days of absence due to a work related injury, and thereafter, receive Statutory Workers’ Compensation Benefits which is 2/3 of the employee’s average weekly wage, subject to a maximum figure, which is established and adjusted each year by statute. • The injured employee must return a copy of the doctor’s report to their supervisor after each doctor’s visit. This report will give the prognosis and the date the employee must return for follow-up visits. • It is the duty and the responsibility of the injured employee to keep his/her supervisor advised of their return to work status.
After‐Hours Care. HMO participating providers have systems in place to respond to your needs when their business offices are closed. These systems may include the use of an answering service or a recorded telephone message informing patients how to access further care.
After‐Hours Care. Group shall provide (or subcontract as necessary to provide) access to after hours services in accordance with Group protocols and community standards of care.
After‐Hours Care. There may be times when you need to speak to the LIFE Provider and receive advice or treatment for an injury or onset of a serious illness which simply cannot wait until regular LIFE day center hours. Please follow the instructions outlined below for afterhours care. • When you need care after hours, there will always be an on-call provider available to answer your call, 24 hours a day, 7 days a week, 365 days a year. • The on-call provider answering your call may not be the same one you see at LIFE, but he/she has been chosen by LIFE to answer your after-hours calls and is well qualified to give you the care you need or arrange to provide care. • If the on-call provider believes you need to go to the hospital, he or she will call the ambulance for you. For afterhours care, call LIFE at 000-000-0000 and the answering service will contact the on-call provider for you. The telephone number is listed on your membership card. For the hearing impaired, call the North Carolina Relay Operator 0-000-000-0000. To leave a message for any of the professionals on your team or any LIFE staff member, call (910) 000- 0000 and give the answering service your message. You are not required to use the LIFE on-call service when you believe that you have a life-threatening condition or have an Emergency Medical Condition. Please use the “911” emergency response system if you believe you have an Emergency Medical Condition and require ambulance services.
After‐Hours Care. Even when our offices are closed, you can call and speak with our after-hours service line for evening and weekend medical care advice at 000-000-0000. CMU Health also offers an evening Pediatric clinic at our Houghton Avenue location for sick visits on Mondays and Tuesdays from 5 - 7 p.m.
After‐Hours Care. There may be times when you need to speak to a physician or nurse practitioner and receive advice or treatment for an injury or onset of a serious illness that simply cannot wait until regular clinic hours. Please follow the instructions outlined below for After Hours Home Care. When you need care after hours, there will always be a doctor and nurse practitioner available to answer your call, 24 hours a day, 7 days a week, 365 days a year. The doctor answering your call may not be the same one you see at Trinity Health LIFE New Jersey, but he/she has been chosen by your doctor to answer your after-hours calls and is well qualified to give you the care you need or arrange to provide care. If the physician or nurse practitioner believes you need to go to the hospital, he or she will call the ambulance for you. 15 For after-hours care, call Trinity Health LIFE New Jersey at (000) 000-0000 and the answering service will contact the physician for you. The telephone number is listed on your membership card. For the hearing impaired, call the New Jersey Relay Operator 0(000) 000-0000 To leave a message for any of the professionals on your team or any Trinity Health LIFE New Jersey staff member, call (000) 000-0000 and give the answering service your message. For the hearing impaired, call the New Jersey Relay Operator 0 (000) 000-0000 You are not required to use the Trinity Health LIFE New Jersey answering service when you believe that you have a life threatening condition or have an emergency. Please use the “911” emergency response system when you have an Emergency Medical Condition and require ambulance transport services or if you reasonably believe that the medical condition is an Emergency Medical Condition and reasonably believe that the condition requires ambulance transport services.
After‐Hours Care a) We are honored to provide you with after hours care. It is our pleasure to understand your pace and life style and do our best to accommodate to your needs. You can apply for Full Time Afternoon Care under same Terms and Conditions as Day Time Care (same rates and policy). Also you can apply for Part Time Afternoon Care under same Terms and Conditions as Part Time Day (rates and policy)
After‐Hours Care. Section 5.4 of the 2008 PSA outlines a one-time PEM Group Bonus Payment for After Hours Care for physician groups who have successfully reduced their enrolled patients’ use of Emergency Departments based on target levels for CTAS IV and V patients. The After Hours bonus has been calculated for the fiscal period 2011/12 with payments divided equally among all eligible physicians. A list of physicians in each group at the end of the fiscal period (March 31, 2012) was used to determine which physicians are eligible to receive the 2011/12 bonus payment, i.e. it is based on group affiliation as of March 31, 2012. Payments will be made to eligible physicians on their August 2013 solo Remittance Advice. The 2008 PSA further required that CTAS IV and V targets be sensitive to rurality. To achieve this, groups were divided into three categories based on the Rurality Index of Ontario (RIO) score linked to the group practice address (RIO 0, RIO 1 to 39, and RIO 40 or more). Those groups with lowest CTAS IV and V Emergency Department usage (those within the top quartile within each RIO range) were eligible for the bonus. A total of 182 groups (1,808 physicians) were eligible for the PEM Group Bonus Payment for After Hours Care resulting in a payment of $1,382.74 per eligible physician. The bonus payment will be reported under the Accounting Transaction: • “After Hours 2008 Bonus 2011/2012” Out of Office Care Appendix E Section 3.1 of the 2008 PSA provides for a PEM Group Bonus Payment for Out of Office Care. This bonus program rewards top performing groups who have a roster population reflective of their community and who provide a broad range of out of office services which meet the needs of their enrolled patients. The Out of Office bonus will be calculated for two separate fiscal periods: $2.5 million dollars in 2011/12 and $2.5 million dollars in 2012/13. The methodology for determining eligibility for this premium is divided into two steps:
After‐Hours Care. If you need services after hours, first contact your assigned Plan provider. Plan providers are required to have 24-hour access to on-call care. If you are unable to contact your Plan provider, this plan provides for reimbursement for any emergency or after hours care out of the area up to $100, less any usual copayments required for any procedures performed on a fee-for-service basis. If you need such care after hours, you must notify the Plan within 48 hours of receiving care from a non-participating provider. Out-of-Area Care: To receive dental care out of your area, first contact Customer Care at the toll-free number listed on your dental ID card to determine if you can be served by another contracted Plan provider. If you are more than 50 miles from a contracted Plan provider, you may be directed to seek care from a non-Plan provider. If you need services after hours, please refer to the above After Hours Care section. WHAT ARE THE BENEFITS? PREVENTIVE BASIC MAJOR Exams Fillings Crowns Cleanings Simple Extractions Molar Root Canal X-rays Dentures Periodontal Surgery HOW IS CARE RECEIVED? The member may receive care by simply calling the selected dental location to schedule an appointment. There are no forms or cards required. WHAT ABOUT MISSED APPOINTMENTS? If a member fails to cancel an appointment at least 24 hours in advance, a “failed appointment fee” will be charged and no further appointments will be made until the cancellation fee is paid. Benefit Schedule HOW DOES YOUR DENTAL PLAN WORK? PACIFIC UNION DENTAL has created a Plan that offers our members quality dental health services at a significant savings. We have contracted with quality, local dental professionals to provide services to you and your eligible dependents at no cost or for low fixed copayments. The following is an example of the potential savings on a typical case. PUD Usual & Customary Fees Office Exam & X-rays No Charge $45 Cleanings (2) - one every 6 months No Charge $90 TAKE ADVANTAGE OF THE BENEFITS In addition to substantial savings, there are many other advantages as described in this brochure. Under this plan, there are no claim forms to complete, no deductibles to be met and no yearly dollar maximum of coverage. MEMBERSHIP ELIGIBILITY This plan is designed for the employee and, if eligible, his/her family. Unless stated otherwise by your group, coverage is extended to the spouse and/or unmarried dependent children. Dependent children include: 1. All natural, 2. Adopted, ...
