Benefits Details Sample Clauses

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 $3,000 per Family Unit per calendar year for family coverage Until the total family annual Deductible is met, benefits will not be provided for any family member Lifetime Maximum No lifetime maximum on covered Essential Health Benefits Out-of-pocket Limit Limited to a maximum of $7,000 per calendar year for family 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,...
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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. “
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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 $250 per Member per calendar year or $500 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 $2,000 per Member or $4,000 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. After Deductible, Member pays $25 Copayment 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 ca...
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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...
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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. “
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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. “
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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
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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. “
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Benefits Details 
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Related to Benefits Details

  • Benefits   on In the event of a lay-off of a full-time employee, the Hospital shall pay its share of insured benefits premium up to three (3) months from the end of the month in which the lay-off occurs or until the laid off employee is employed elsewhere, whichever occurs first.

  • Benefits; Vacation Employee shall be eligible to receive all benefits as are available to similarly situated employees of Employer generally, and any other benefits that Employer may, in its sole discretion, elect to grant to Employee from time to time. In addition, Employee shall be entitled to four (4) weeks paid vacation per year, which shall be pro-rated for the first partial year of employment and shall accrue in accordance with Employer’s policies applicable to similarly situated employees of Employer.

  • Standard Company Benefits Executive shall be entitled to participate in all employee benefit programs for which Executive is eligible under the terms and conditions of the benefit plans that may be in effect from time to time and provided by the Company to its employees. The Company reserves the right to cancel or change the benefit plans or programs it offers to its employees at any time.

  • Customary Fringe Benefits Executive will be eligible for all customary and usual fringe benefits generally available to executives of Company subject to the terms and conditions of Company’s benefit plan documents. Company reserves the right to change or eliminate the fringe benefits on a prospective basis, at any time, effective upon notice to Executive.

  • Benefits Plans During the Employment Period, You will be eligible to participate in all benefit plans in effect for executives and employees of the Company, subject to the terms and conditions of such plans.

  • Company Benefits Subject to the satisfaction of the general rules for eligibility and participation under the Company’s standard employee benefit plans and practices, Executive shall be allowed to participate in the Company’s standard employee benefit plans and practices which may be in effect from time to time during the term of Executive’s employment and are provided by the Company to its employees generally. Such participation shall be governed by the applicable plan documents, and the Company reserves the right, in its discretion, to amend, modify, or discontinue any benefit plan or practice.

  • Benefits Acknowledged The Guaranteeing Subsidiary’s Guarantee is subject to the terms and conditions set forth in the Indenture. The Guaranteeing Subsidiary acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture and this Supplemental Indenture and that the guarantee and waivers made by it pursuant to this Guarantee are knowingly made in contemplation of such benefits.

  • Standard Benefits During the Employment Period, Executive shall be entitled to participate in all employee benefit plans and programs, including paid vacations, generally available to other similarly situated Company executives, subject to the terms and conditions of the applicable plans.

  • Additional Benefits/Card Enhancements The Credit Union may from time to time offer additional services to your account, such as travel accident insurance, at no additional cost to you. You understand that the Credit Union is not obligated to offer such services and may withdraw or change them at any time.

  • Group Benefits To determine if a leave under the provisions of the Family and Medical Leave Act will be a paid or unpaid leave, contact the District’s Human Resources Department.

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