Benefit Package. A. The following categories of services shall be provided by the contractor for all Medicaid and NJ FamilyCare Plans A, B, and C enrollees, except where indicated. See Section B.4.1 of the Appendices for complete definitions of the covered services.
1. Primary and Specialty Care by physicians and, within the scope of practice and in accordance with State certification/licensure requirements, standards and practices, by Certified Nurse Midwives, Certified Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants
2. Preventive Health Care and Counseling and Health Promotion
3. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program Services For NJ FamilyCare Plans B and C participants, coverage includes early and periodic screening and diagnosis medical examinations, dental, vision, hearing, and lead screening services. It includes only those treatment services identified through the examination that are available under the contractor's benefit package or specified services under the FFS program.
Benefit Package. AB-PMJAY Cover 16
Benefit Package. A. The following categories of services shall be provided by the Contractor for all Medicaid and NJ FamilyCare A, B, C, D and ABP enrollees, except where indicated. See Section B.4.1 of the Appendices for complete definitions of the covered services.
1. Primary and Specialty Care by physicians and, within the scope of practice and in accordance with State certification/licensure requirements, standards and practices, by Certified Nurse Midwives, Doulas, Certified Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants
2. Preventive Health Care and Counseling and Health Promotion
3. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Services For NJ FamilyCare B, C and D enrollees, coverage includes early and periodic screening and diagnostic medical examinations, dental, vision, hearing, and lead screening services. It includes only those treatment services identified through the examination that are available under the Contractor’s benefit package or specified services under the FFS program. NJ FamilyCare members eligible for EPSDT program services shall not be assessed/referred for new MLTSS enrollment unless an MLTSS specific benefit is medically necessary and not available through any other funding source. NJ FamilyCare members aging out of EPSDT benefits may be assessed/referred for MLTSS enrollment up to six months in advance of their 21st birthday.
4. Emergency Medical Care
5. Inpatient Hospital Services including acute care hospitals, rehabilitation hospitals, and specialty care hospitals whether within New Jersey or out of state.
6. Outpatient Hospital Services 7. Laboratory Services.
Benefit Package. For services started while member is enrolled in NJFC FFS Program
Benefit Package.
40:01 The parties agree that during the life of this collective agreement, the benefit plan will be cost-shared on a 50-50 basis for the following plans:
40:02 All plan documents are available from the Employer to the Employees for information.
40:03 The above noted benefits shall be subject to the terms and conditions of the master policies issued to the Employer by the insuring organization.
40:04 None of the above noted plans shall form part of the Agreement, but it is agreed that any failure by the Employer to provide coverage for eligible Employees shall entitle the Union to submit such failure to arbitration.
40:05 Coverage under the Dental and Extended Health Care Plans shall be made available to be maintained at the employee’s cost during any unpaid leave required to satisfy elimination period or date of initial decision, whichever is later, for the Long Term Disability Plan.
Benefit Package. The benefits offered to the Executive by Qualstar, including but not limited to, Medical, Dental, Life Insurance, Short Term or Long Term Disability, Holidays, 401(K), etc., shall be exactly the same as offered by the Company to other employees. No exclusive top-tier benefit plans shall be offered, as part of Executive compensation.
Benefit Package. AB-PMJAY Cover
a. The benefits within this Scheme under the Risk Cover are to be provided on a cashless basis to the AB-PMJAY Beneficiaries up to the limit of their annual coverage and includes:
(i) Hospitalization expense benefits
(ii) Day care treatment benefits (as applicable) (iii)Follow-up care benefits
Benefit Package. The Employer agrees to provide the Association's Benefit package for the general and service employees.
Benefit Package. The Benefits within this scheme, to be provided on a cashless basis to the Beneficiaries up to the limit of their annual coverage, package charges on specific procedures and subject to other terms and conditions outlined herein, are the following:
a. The scheme shall provide coverage for meeting expenses of hospitalization for medical and/or surgical procedures including maternity benefit, to the enrolled families for up to Rs.30,000 per family per year subject to limits, in any of the empanelled hospitals across India. The benefit to the family will be on floater basis, i.e., the total reimbursement of Rs.30,000 can be availed individually or collectively by members of the family per year.
b. Pre-existing conditions/diseases are to be covered from the first day of the start of policy, subject to the exclusions given in Appendix 1.
c. Coverage of health services related to surgical nature for defined procedures shall also be provided on a day care basis. The Insurance Company shall provide coverage for the defined day care treatments/ procedures as given in Appendix 2.
d. Provision for transport allowance of Rs. 100 per hospitalization subject to an annual ceiling of Rs. 1000 shall be a part of the package. This will be provided by the hospital to the beneficiary at the time of discharge in cash.
e. Pre and post hospitalization costs up to 1 day prior to hospitalization and up to 5 days from the date of discharge from the hospital shall be part of the package rates.
f. Maternity and Newborn Child will be covered as indicated below:
I. It shall include treatment taken in hospital/nursing home arising out of childbirth, including normal delivery / caesarean section and/ or miscarriage or abortion induced by accident or other medical emergency subject to exclusions given in Appendix 1.
II. Newborn child shall be automatically covered from birth upto the expiry of the policy for that year for all the expenses incurred in taking treatment at the hospital as in-patient. This benefit shall be a part of basic sum insured and new born will be considered as a part of insured family member till the expiry of the policy subject to exclusions given in Appendix 1.
III. The coverage shall be from day one of the inception of the policy. However, normal hospitalisation period for both mother and child should not be less than 48 hours post delivery.
i. For the ongoing policy period until its renewal, new born will be provided all benefits under RSBY and will NOT be counted ...
Benefit Package. When orthodontic services are paid at a case rate, treatment shall continue within the time period covered by the payment.
1. Upon change in enrollment to a new NJFC-MCO, the new NJFC-MCO will provide reimbursement for previously approved dental services that were already in progress and subsequently completed after the change in MCO enrollment. Upon change in MCO enrollment to the FFS Program, the FFS program will provide reimbursement for previously approved dental services that were already in progress and subsequently completed after the enrollment change.
