Benefits Details. Benefits are subject to all provisions of the EOC. Members are entitled only to receive benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by KFHPWA’s medical director and as described herein. All Covered Services are subject to case management and utilization management. Annual Deductible Subscriber pays $1,500 per calendar year for Subscriber only coverage Coinsurance Plan Coinsurance: Member pays 20% Lifetime Maximum No lifetime maximum on covered Essential Health Benefits Out-of-pocket Limit Limited to a maximum of $3,500 per calendar year for Subscriber only coverage The following Out-of-pocket Expenses apply to the Out-of-pocket Limit: All Cost Shares for Covered Services The following expenses do not apply to the Out-of-pocket Limit: Premiums, charges for services in excess of a benefit, charges in excess of Allowed Amount, charges for non-Covered Services Pre-existing Condition Waiting Period No pre-existing condition waiting period Acupuncture Acupuncture needle treatment, limited to 12 visits per calendar year without Preauthorization. No visit limit for treatment for Substance Use Disorder. After Deductible, Member pays 20% Plan Coinsurance Exclusions: Herbal supplements; any services not within the scope of the practitioner’s licensure Allergy Services Allergy testing. After Deductible, Member pays 20% Plan Coinsurance Allergy serum and injections. After Deductible, Member pays 20% Plan Coinsurance Ambulance Emergency ground or air transport to any facility. After Deductible, Member pays 20% Plan Coinsurance Non-Emergency ground or air interfacility transfer to or from a Network Facility when Preauthorized by KFHPWA, including hospital-to-hospital ground transfers. Contact Member Services for Preauthorization. After Deductible, Member pays 20% Plan Coinsurance Hospital-to-hospital ground transfers: After Deductible, Member pays nothing Cancer Screening and Diagnostic Services Routine cancer screening covered as Preventive Services in accordance with the well care schedule established by KFHPWA and the Patient Protection and Affordable Care Act of 2010. The well care schedule is available in Xxxxxx Permanente medical centers, at xxx.xx.xxx/xx, or upon request from Member Services. See Preventive Services for additional information. No charge; Member pays nothing Diagnostic laboratory and diagnostic services for cancer. See Diagnostic Laboratory and Radiology Servic...
Benefits Details. Benefits are subject to all provisions of the Agreement. Members are entitled only to receive benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by KFHPWA’s medical director and as described herein. All Covered Services are subject to case management and utilization management. Benefits available will not duplicate benefits provided under any other KFHPWA medical coverage Agreement. “
Benefits Details. Benefits are subject to all provisions of the EOC. Members are entitled only to receive benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by KFHPWA’s medical director and as described herein. All Covered Services are subject to case management and utilization management. Annual Deductible Subscriber pays $1,600 per contract year for Subscriber only coverage Coinsurance Plan Coinsurance: Member pays 20% Lifetime Maximum No lifetime maximum on covered Essential Health Benefits Out-of-pocket Limit Limited to a maximum of $3,500 per calendar year for Subscriber only coverage The following Out-of-pocket Expenses apply to the Out-of-pocket Limit: All Cost Shares for Covered Services The following expenses do not apply to the Out-of-pocket Limit: Premiums, charges for services in excess of a benefit, charges in excess of Allowed Amount, charges for non- Covered Services Pre-existing Condition Waiting Period No pre-existing condition waiting period Acupuncture Acupuncture needle treatment, limited to 12 visits per calendar year without Preauthorization. No visit limit for treatment for Substance Use Disorder. After Deductible, Member pays 20% Plan Coinsurance Exclusions: Herbal supplements; any services not within the scope of the practitioner’s licensure Advanced Care at Home Advanced Care at Home is a personalized, patient-centered program that provides care for patients with certain clinical conditions in their homes, or at another appropriate care location. Advanced Care at Home services must be associated with an acute episode in which the member is treated for a brief but severe episode of illness, for conditions that are the result of disease such as, but not exclusive to, congestive heart failure, pneumonia, upper urinary tract infection or cellulitis. The treatment plan may include restorative care associated with the acute episode. The duration of an episode of care (which includes acute and restorative phases) is limited to a total of 30 days. To receive advanced care in the home: • The member must be referred into the advanced care program by the managing provider at an emergency room, urgent care, or inpatient setting, • Advanced Care at Home requires Preauthorization based on the Member’s health status, treatment plan, and home setting or another appropriate care location within the Service Area, • The clinical condition must meet inpatient Medical Necessity criteria, ...
Benefits Details. Benefits are subject to all provisions of the Benefits Booklet. Members are entitled only to receive benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by Group Health’s medical director and as described herein. All Covered Services are subject to case management and utilization management at the discretion of Group Health. “
Benefits Details. Benefits are subject to all provisions of the Benefits Booklet. Members are entitled only to receive benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by KFHPWA’s medical director and as described herein. All Covered Services are subject to case management and utilization management. “
Benefits Details. MUNICPAL PENSION PLAN (MPP) The MPP is a defined benefit plan, which means your pension is based on the number of years you made contributions to the plan and the average of your highest five years of salary (not necessarily your last 5 years). It is not based on your contributions to the plan or on the performance of the plan’s assets. BASIC HEALTH CARE - BC MEDICAL SERVICES PLAN (MSP) Insures medically required services provided by physicians, laboratory services and diagnostic procedures Richmond Olympic Oval covers 80% of the monthly premium EXTENDED HEALTH AND DENTAL All prescriptions & paramedical services are out-of-pocket expenses and a claim form must be submitted for reimbursement. Coverage is at 80%, will become 100% once $2000 has been paid per person per calendar year. Richmond Olympic Oval covers 100% of the monthly premium Benefit Description Coverage Prescriptions Drugs and medical supplies prescribed in writing by a doctor or dentist and obtained from a pharmacist 80% Hospital Care Within BC only. Additional charge for semi-private or private room accommodation in a: Hospital or extended care unit 100% Convalescent facility $20/day to a max of 120 days Paramedical services Acupuncturist Chiropractor (+1 x-ray/calendar yr) Massage Practitioner Naturopath Physiotherapist Podiatrist (+1 x-ray/calendar yr) Psychologist Speech Language Pathologist Effective 2017 September 01 $200 per service per calendar year Private Duty Care Registered nurse for an acute condition. Max of $10,000/calendar yr or $25,000/lifetime, whichever occurs first. Other Coverage Fertility Drug $3000/person/lifetime Smoking Cessation $250/person/lifetime Mastectomy Bra $250/person/calendar yr Wigs $500/person/lifetime Xxxxx Socks $250/person/calendar yr Surgical Stocking $250/person/calendar yr Orthopaedic Shoe $300/person/calendar yr Hearing Aids $500 every 5 calendar years Emergency Travel Out of Country emergency medical for you and your Dependents Up to 60 consecutive days of travel per trip Dental Coverage: effective 2017 September 01 $1,500 maximum per person, per calendar year for all combined dental services Diagnostic Exams & X-rays (refer to the Group benefit booklet for details) *80% Preventative Cleanings (2 per year) *80% Basic Services Fillings, Endontics (root canal therapy, fillings), Periodontics (bone/gum) *80% Major Restorative Services Inlays, onlays, crowns, veneers, dentures, bridges, prosthodontics *50% *Percentages are applied against the “Dental F...
Benefits Details. Benefits are subject to all provisions of the EOC. Members are entitled only to receive benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by KFHPWA’s medical director and as described herein. All Covered Services are subject to case management and utilization management. “
