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 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 Pre-existing Condition Waiting Period No pre-existing condition waiting period 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 Allergy testing. After Deductible, Member pays 20% Plan Coinsurance Allergy serum and injections. After Deductible, Member pays 20% Plan Coinsurance 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 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 Services for additional information. Preventive laboratory/radiology services are covered as Preventive Services. After Deductible, Member pays 20% Plan Coinsurance Circumcision. Non-Emergency inpatient hospital services require Preauthorization. Hospital - Inpatient: After Deductible, Member pays 20% Plan Coinsurance Hospital - Outpatient: After Deductible, Member pays 20% Plan Coinsurance Outpatient Services: After Deductible, Member pays 20% Plan Coinsurance
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 Member pays $0 per Member per calendar year or $0 per Family Unit per calendar year Lifetime Maximum No lifetime maximum on covered Essential Health Benefits Out-of-pocket Limit Limited to a maximum of $1,500 per Member or $3,000 per Family Unit per calendar year Pre-existing Condition Waiting Period No pre-existing condition waiting period Acupuncture needle treatment, limited to 12 visits per calendar year without Preauthorization. No visit limit for treatment for Substance Use Disorder. Member pays $35 Copayment and 20% Plan Coinsurance 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, • The Member must consent to receiving advanced care described in the treatment plan, • The care location, such as the member’s residence, must be within 30 minutes ground travel time of an emergency department, and • The care location, such as the member’s residence, must, have cell service. Advanced Care at Home is provided through Medically Home, our Network provider, and they will provide the following services in the Member’s home or appropriate...
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. 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 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 Pre-existing Condition Waiting Period No pre-existing condition waiting period 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 Allergy testing. After Deductible, Member pays 20% Plan Coinsurance Allergy serum and injections. After Deductible, Member pays 20% Plan Coinsurance Emergency ambulance service is covered only when: • Transport to the nearest facility that can treat your condition • Any other type of transport would put your health or safety at risk. • The service is from a licensed ambulance. Emergency air or sea medical transportation is covered only when: • The above requirements for ambulance service are met, and • Geographic restraints prevent ground Emergency transportation to the nearest facility that can treat your condition, or ground Emergency transportation would put your health or safety at risk. 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 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 Services for additional in...
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. “
Benefits Details. MUNICPAL PENSION PLAN (MPP) Richmond Olympic Oval covers 80% of the monthly premium EXTENDED HEALTH AND DENTAL Richmond Olympic Oval covers 100% of the monthly premium Benefit Description Coverage HEALTH SPENDING ACCOUNT (HSA) LIFE INSURANCE & DISABILITY INSURANCE
Benefits Details
