Covered Services. You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.
Covered Services. Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.
Covered Services. Health care services or products for which a Covered Person is enrolled with Health Plan to receive coverage under the State Contract.
Covered Services. (A) The Contractor shall administer Medically Necessary Covered Services, in a manner that is no more restrictive than the State Medicaid program, including quantitative and non-quantitative treatment limits, as indicated in State statutes and regulations, the State Plan, and other State policies, procedures, and administrative rules.
Covered Services. 1. In addition to the coverage and authorization of services requirements set forth in Article II.E.4 of this Agreement, the Contractor shall:
Covered Services. Health care services or products for which a Covered Person is enrolled with United to receive coverage under the State Contract.
Covered Services. Benefits for medically necessary Covered Drugs are available if the drug:
Covered Services. Coverage will be provided for Members age 19 and over for one (1) routine eye examination, including dilation, if professionally indicated, each Benefit Period. A vision examination may include, but is not limited to:
Covered Services. This section describes the services this plan covers. Covered service means medically necessary services (see Definitions) and specified preventive care services you get when you are covered for that benefit. This plan provides benefits for covered services only if all of the following are true when you get the services: The reason for the service is to prevent, diagnose or treat a covered illness, disease or injury The service takes place in a medically necessary setting. For more information about what medically necessary means, see Definitions. The service is not excluded The provider is working within the scope of their license or certification This plan may exclude or limit benefits for some services. See the specific benefits in this section and the Exclusions section for details. Benefits for covered services are subject to the following: Copays Deductibles Coinsurance Benefit limits Prior Authorization. Some services must be authorized in writing before you get them. These services are identified in this section. See the Prior Authorization section for more information. Medical and payment policies. The plan has policies that are used to administer the terms of the plan. Medical policies are generally used to further define medical necessity or investigational status for a specific procedure, drugs, biologic agents, devices, level of care or services. Payment policies define provider billing and payment rules. Our policies are based on accepted clinical practice guidelines and industry standards accepted by organizations like the American Medical Association (AMA), other professional societies and the Center for Medicare and Medicaid Services (CMS). Our policies are available to you and your provider at xxxxxxx.xxx or by calling Customer Service. If you have any questions regarding your benefits and how to use them, call Customer Service at the number listed on the back cover. COMMON MEDICAL SERVICES The services listed in this section are covered as shown on the Summary of Your Costs. Please see the summary for your copays, deductible, coinsurance, benefit limits and if out-of-network services are covered.
