Covered Medical Services/ In-Network Out Sample Clauses

Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment* Payment* 4 Routine mammography 90% after deductible 80% after (One 5 mammogram per calendar deductible 6 year for covered females 40 7 and over) 9 Specialist (office visits) 90% after deductible 80% after 10 deductible 12 Surgery 90% after deductible 80% after 13 deductible 15 Physician in-hospital services 90% after deductible 80% after 16 deductible 18 Allergy testing and treatment 90% after deductible 80% after 19 deductible 20 21 Allergy injections 90% after deductible 80% after 22 deductible 23 24 Immunizations and injections 90% after deductible 80% after 25 (immunizations at 100% deductible 26 with deductible waived (immunizations at 27 for children, birth to 100% with 28 age 6) deductible waived 29 for children, birth 30 to age 6) 31 32 Other physician services 90% after deductible 80% after 33 deductible 34 35 Maternity (coverage includes 90% after deductible 80% after 36 voluntary sterilization and deductible 37 voluntary abortion) 38 39 40 *Once both the annual (calendar year) deductible and the co-insurance limit have been reached, all medical services 41 received for the remainder of the calendar year are benefited at 100 percent (except for: office visit, urgent care, 42 emergency room, and prescription co-pays; co-insurance payments for outpatient mental health, outpatient
Sample 1
AutoNDA by SimpleDocs
Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment Payment*
Sample 1
Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment Payment* 4 Mental Health Services 5 Inpatient coverage 100% up to 120 days 80% after 6 per calendar year**** deductible up to 7 40 days per 8 calendar year**** 10 Outpatient coverage 100% up to 120 visits 80% after 11 (including all mandated per calendar year**** deductible** up to 12 providers) 30 visits per 13 calendar year****
Sample 1
Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment Payment* 4 Organ Transplants (see National 100% 80% after 5 Program for Medical Excellence) deductible 7 Physical/Speech/Occupational 100% 80% after 8 Therapy (inpatient and out- deductible 9 patient) 10 11 Radiation Therapy (inpatient and 100% 80% after 12 outpatient) deductible 13 14 Chemotherapy (inpatient and out- 100% 80% after 15 patient) deductible 16 17 Blood/Blood Plasma 100% 80% after 18 deductible 20 Chiropractic 100% up to 50 visits 80% after 21 per calendar year*** deductible up to 22 50 visits per 23 calendar year*** 24 25 Oral Surgery (procedures covered 100% 80% after 26 by Aetna U.S. Healthcare on deductible 27 October 27, 2000) 28 29 TMJ (surgical and non-surgical 100% 80% after 30 diagnosis and treatment) deductible 31 32 Prosthetic/Orthotic Appliances 100% 80% after 33 deductible 34
Sample 1
Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment* Payment* 4 Contraceptives (including 90% after deductible 80% after 5 injectable contraceptives that deductible 6 are not self-administered and 7 inserted and implanted contra- 8 ceptive devices) 10 Infertility Treatment 90% after deductible 80% after 11 Artificial insemination (6 cycles deductible 12 lifetime maximum). Advanced 13 reproductive technology, including 14 in vitro fertilization, GIFT, ZIFT 15 to lifetime maximum of $30,000. 17 Diagnostic X-Ray & Laboratory 90% after deductible 80% after 18 (other than physician's office) deductible 19 20 Durable Medical Equipment 90% after deductible 80% after 21 deductible
Sample 1
Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment* Payment* 4 Mail-order pharmacy program 100% after $10 generic N/A 5 (Medco) and $20 brand co-pay 6 for a 90-day supply 8 Mental Health Services 9 Inpatient coverage 90% after deductible 80% after 10 up to 120 days per deductible up to 11 calendar year*** 40 days per 12 calendar year*** 14 Outpatient coverage 90% after deductible** 80% after 15 (including all mandated up to 120 visits per deductible** up to 16 providers) calendar year*** 30 visits per 17 calendar year*** 18
Sample 1
Covered Medical Services/ In-Network Out of-Network 2 Plan Design Features Payment* Payment* 4 Claim Submission Provider initiated. Member initiated, 5 Two-year filing member 6 requirement ultimately 7 responsible.
Sample 1
AutoNDA by SimpleDocs

Related to Covered Medical Services/ In-Network Out

  • Paramedical Services Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages:

  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment.

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Emergency Medical Services The City’s Fire Department and MedStar (or other entity engaged by the City after the Effective Date) will provide emergency medical services.

  • Surgical Services All necessary procedures for extractions and other surgical procedures normally performed by a dentist.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Technical Services Party B will provide technical services and training to Party A, taking advantage of Party B’s advanced network, website and multimedia technologies to improve Party A’s system integration. Such technical services shall include:

  • Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.

  • Telemedicine Services This plan covers clinically appropriate telemedicine services when the service is provided via remote access through an on-line service or other interactive audio and video telecommunications system in accordance with R.I. General Law § 27-81-1. Clinically appropriate telemedicine services may be obtained from a network provider, and from our designated telemedicine service provider. When you seek telemedicine services from our designated telemedicine service provider, the amount you pay is listed in the Summary of Medical Benefits. When you receive a covered healthcare service from a network provider via remote access, the amount you pay depends on the covered healthcare service you receive, as indicated in the Summary of Medical Benefits. For information about telemedicine services, our designated telemedicine service provider, and how to access telemedicine services, please visit our website or contact our Customer Service Department.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. Preauthorization may be required for certain surgical services. Reconstructive Surgery for a Functional Deformity or Impairment This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia. Preauthorization may be required for these services.

Time is Money Join Law Insider Premium to draft better contracts faster.