COVERED MEDICAL SERVICES Clause Samples
COVERED MEDICAL SERVICES. The Covered Benefits or Covered Services described below may be subject to Limitations, as described in Part X. LIMITATIONS OF COVERED MEDICAL SERVICES and Exclusions as described in Part XI. EXCLUSIONS FROM COVERED MEDICAL SERVICES. Please refer to Parts X. LIMITATIONS OF COVERED MEDICAL SERVICES and XI. EXCLUSIONS FROM COVERED MEDICAL SERVICES for applicable benefit maximums, and services that are excluded under this Contract.
COVERED MEDICAL SERVICES. Expenses for microprocessor controlled or myoelectric artificial limbs (e.g. C-legs); and expenses for cosmetic enhancements to artificial limbs are also not covered.
COVERED MEDICAL SERVICES. Covered medical services for purpose of this Agreement are those services that meet all of the following criteria:
(a) The individual receiving services is an eligible IMAP customer.
(b) The service is a covered IMAP service in accordance with approved state plan methodologies.
(c) The provider is an IMAP enrolled provider.
(d) The rates for services are consistent with state plan requirements.
(e) IMAP payments do not duplicate other specific payments for the same service.
(f) HFS and ▇▇▇ maintain auditable documentation to support claims for Federal Financial Participation (FFP).
(g) HFS conducts appropriate financial oversight over LEA billing practices.
(h) Third Party Liability requirements are met. (CMS does not view public schools carrying out general responsibilities to ensure access to needed health care as legally liable third parties.)
(i) All other statutory, regulatory, and policy requirements for service, payment, and associated claiming are met.
COVERED MEDICAL SERVICES. For more information about covered pediatric dental benefits please see Part XVIII. PEDIATRIC DENTAL BENEFITS.
COVERED MEDICAL SERVICES. Subject to the terms, conditions, exclusions and limitations set forth in the Schedule of Benefits (including the copayment, co-insurance and maximum benefit amounts set forth therein) and in this Policy, the Company will pay and provide to each Covered Person the benefits described below.
COVERED MEDICAL SERVICES. We will pay for the following medical services:
a. General medical and specialist care, including consultations and referrals.
b. Preventive health services and physical examinations. We will pay for preventive health services including:
i. Periodic routine physical examinations for adults aged nineteen (19) and older no more than once every three (3) years.
ii. Adult immunizations.
iii. Well child visits for covered children under age nineteen (19) in accordance with the prevailing clinical standards of the American Academy of Pediatrics, including an initial hospital checkup and necessary immunizations as determined by the Superintendent of Insurance in consultation with the Commissioner of Health consisting of at least adequate dosages of vaccine against diphtheria, pertussis, tetanus, polio, measles, rubella, mumps, haemophilus influenza type b and hepatitis b and varicella. We will cover services typically provided in conjunction with a well child visit. Such services include at least: complete medical histories; a complete physical examination; developmental assessments; anticipatory guidance; laboratory tests performed in the practitioner’s office or in a clinical laboratory and/or other services ordered at the time of the well child visit; nutrition education and counseling; hearing testing; medical social services; eye screening; tuberculin testing; dental and developmental screening; clinical laboratory and radiological testing; and lead screening.
COVERED MEDICAL SERVICES. We will pay for the following medical services:
COVERED MEDICAL SERVICES. The summary description (b above) 27 lists some of the medical services and supplies covered by the comprehensive 28 indemnity/PPO plan, but is not intended to be an exhaustive list of all services and 29 supplies covered by the plan. The comprehensive indemnity/PPO plan shall cover 30 all medically necessary services and supplies which are not excluded by the plan, 31 subject to the following:
COVERED MEDICAL SERVICES. The summary description (2 2 above) lists some of the medical services and supplies covered by the PPO 3 indemnity health plan, but is not intended to be an exhaustive list of all 4 services and supplies covered by the plan. The PPO indemnity health plan 5 shall cover all medically necessary services and supplies which are not 6 excluded by the plan, subject to the following: