DIALYSIS AND TRANSPLANT SERVICES Sample Clauses

DIALYSIS AND TRANSPLANT SERVICES. 1. Dialysis. Subject to the terms and conditions of this section, medical services and Hospital Services for dialysis for acute renal failure and chronic renal disease are provided in accord with this benefit schedule. The terms and Supplemental Charges in this benefit schedule will apply (e.g. hospital care will be subject to section B, etc.), except outpatient dialysis procedures (including any services or items provided during such procedures) are provided upon payment of 10% of Applicable Charges. Dialysis for chronic conditions of Medicare Members is provided only in facilities certified by Medicare. Medical Group determines whether a condition is chronic or acute. Equipment, training and medical supplies required for home dialysis are provided without charge. For routine dialysis services and supplies to be covered, Member must satisfy all the medical criteria developed by Medical Group.
Sample 1
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DIALYSIS AND TRANSPLANT SERVICES. 1. Dialysis. Subject to the terms and conditions of this section, medical services and Hospital Services for dialysis for acute renal failure and chronic renal disease are provided in accord with this benefit schedule. The terms and Supplemental Charges in this benefit schedule will apply (e.g. office visits will be subject to section A, hospital care will be subject to section B, etc.). Outpatient dialysis for Members with end stage renal disease is provided without charge when in the Service Area and while temporarily away from the Service Area. For routine dialysis services and supplies to be covered, Member must satisfy all the medical criteria developed by Medical Group. Dialysis for chronic conditions of Medicare Members is provided only in facilities certified by Medicare. Medical Group determines whether a condition is chronic or acute. Equipment, training and medical supplies required for home dialysis are provided without charge.
Sample 1

Related to DIALYSIS AND TRANSPLANT SERVICES

  • Dialysis Services This plan covers dialysis services and supplies provided when you are inpatient, outpatient or in your home and under the supervision of a dialysis program. Dialysis supplies provided in your home are covered as durable medical equipment.

  • 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. 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.

  • 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.

  • Diagnostic Services All necessary procedures to assist the dentist in evaluating the existing conditions to determine the required dental treatment, including: Oral examinations Consultations

  • 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.

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

  • Procurement of Goods and Services (a) If the HSP is subject to the procurement provisions of the BPSAA, the HSP will abide by all directives and guidelines issued by the Management Board of Cabinet that are applicable to the HSP pursuant to the BPSAA. (b) If the HSP is not subject to the procurement provisions of the BPSAA, the HSP will have a procurement policy in place that requires the acquisition of supplies, equipment or services valued at over $25,000 through a competitive process that ensures the best value for funds expended. If the HSP acquires supplies, equipment or services with the Funding it will do so through a process that is consistent with this policy.

  • Laboratory Services Covered Services include prescribed diagnostic clinical and anatomic pathological laboratory services and materials when authorized by a Member's PCP and HPN’s Managed Care Program.

  • Inpatient Services Hospital Rehabilitation Facility

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

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