Chronic Obstructive Pulmonary Disease (COPD Sample Clauses

Chronic Obstructive Pulmonary Disease (COPD. The following services related to COPD are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of COPD and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of COPD • Office visits to a Pulmonologist (lung specialist) for consultation and routine management of COPD • Palliative care conversations (chronic condition treatment preferences) with Primary Care Provider or Pulmonologist • Inhaler adjuncts (e.g. holding chamber/spacer) as specified on the Formulary and dispensed through our Home Delivery Program • Pulmonary function tests • Home oxygen therapy assessment (oxygen delivery and supplies are subject to routine coverage) • Pulmonary rehabilitation and associated exercise program at 50% cost share reduction • Targeted laboratory tests for the routine management of COPD Please note, if you have complications from COPD and use an urgent care center, emergency department have a hospital stay, or get a lung resection/transplant, services will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits.
Sample 1
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Chronic Obstructive Pulmonary Disease (COPD. The following services related to COPD are covered with $0 Out - of- Pocket Cost when linked to a primary diagnosis of COPD and performed by a Network Provider: • Office visits to a Primary Care Provider for routine management of COPD • Office visits to a Pulmonolog ist (lung specialist) for consultation and routine management of COPD • Palliative care conversations (chronic condition treatment preferences) with Primary Care Provider or Pulmonologist • Inhaler adjuncts (e.g. holding chamber/ spacer) as specified on the For mulary and dispensed through our Home Delivery Program • Pulmonary function tests SAMPLE • Home oxygen therapy assessment (oxygen deliver y and supplies are subject to routine coverage) • Pulmonary rehabilitation and associated exercise program at 50% cost share reducti on • Targeted laboratory tests for the routine management of COPD Please note, if you have complications from COPD and use an urgent care center, emergency department have a hospital stay, or get a lung resection/ transplant, services will be subject to stand ard Out - of - Pocket Costs as outlined in your Schedule of Benefits .
Sample 1

Related to Chronic Obstructive Pulmonary Disease (COPD

  • Active NFFE An “Active NFFE” means any NFFE that meets any of the following criteria:

  • Infection Control Consistent with the Centers for Disease Control and Prevention Guideline for Infection Control in Health Care Personnel, and University Policy 3364-109-EH-603, the parties agree that all bargaining unit employees who come in contact with patients in the hospital or ambulatory care clinics will need to be vaccinated against influenza when flu season begins each fall. The influenza vaccine will be offered to all health care workers, including pregnant women, before the influenza season, unless otherwise medically contraindicated or it compromises sincerely held religious beliefs.

  • Communicable Diseases (a) The Parties to this Agreement share a desire to prevent acquisition and transmission where employees may come into contact with a person and/or possessions of a person with a communicable disease.

  • Communicable Disease Bodily injury" or "property damage" which arises out of the transmission of a communi- cable disease by an "insured";

  • Serious Health Condition An illness, injury, impairment, or physical or mental condition which warrants the participation of a family member to provide care during a period of treatment or supervision and involves either inpatient care in a hospital, hospice or residential health care facility or continuing treatment or continuing supervision by a health care provider (e.g. physician or surgeon) as defined by state and federal law.

  • Dangerous Goods, Special Wastes, Pesticides and Harmful Substances Where employees are required to work with or are exposed to any dangerous good, special waste, pesticide or harmful substance, the Employer shall ensure that the employees are adequately trained in the identification, safe handling, use, storage, and/or disposal of same.

  • Hepatitis B Vaccine Where the Hospital identifies high risk areas where employees are exposed to Hepatitis B, the Hospital will provide, at no cost to the employees, a Hepatitis B vaccine.

  • Recall from Layoff Full-time and regular part-time nurses shall be recalled in the order of seniority unless otherwise agreed between the Hospital and the local Union, subject to the following provisions, provided that a nurse recalled is qualified to perform the available work:

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Cardiac Rehabilitation Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible Chiropractic Services In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Dental Services - Accidental Injury (Emergency) Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Dental Services- Outpatient Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Dialysis Services Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Durable Medical Equipment (DME), Medical Supplies, Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Early Intervention Services (EIS) Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Education - Asthma Asthma management 0% - After deductible 40% - After deductible Emergency Room Services Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.

  • Involuntary Demotion An employee assigned to a lower rated position shall continue to be paid at the employee's current rate of pay until the rate of pay in the new position equals or exceeds it.

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