Direct Primary Care Services Sample Clauses

Direct Primary Care Services. Each clinic utilizing EverMed DPC is independently owned and operated. *You may or may not have all of the same offerings available at each clinic. EverMed DPC may have discounted prices for services not covered by your EverMed DPC membership. Check with your provider or contact EverMed DPC directly. Included Services
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Direct Primary Care Services. Mequon Wellness Center will provide Member with the direct primary care services specified in Menu of Subscription Services (Appendix A).
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Direct Primary Care Services. Your MD will provide Member with the direct primary care services identified on the Menu of Subscription Services on Appendix A ("Subscription Services").
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Direct Primary Care Services. Each clinic utilizing EverMed DPC is independently owned and operated. You may or may not have all of the same offerings available at each clinic. EverMed DPC may have discounted prices for services not covered by your EverMed DPC membership. Check with your provider or contact EverMed DPC directly. Included Services Services Primary Care Visits Included Urgent Care Visits Included Preventive Care Included Annual Wellness Exams Included Well Child Exams Included Sports Physicals Included Telemedicine** (Email, Phone, Remote Portal Consults) Included Procedures EKG Included PPD (TB Test) Included Injection Fees (medication costs may not be covered) Included Immunizations (medication costs may not be covered) Included Flu Shot Included Ear Irrigation Included Nebulizer Treatments Included Liquid Nitrogen Procedures Included Smoking and Tobacco Cessation Counselling Included Minor Surgical Procedures Included Alcohol and Substance Abuse Screening Included Labs* Urinalysis Included Blood Glucose Included Urine Pregnancy Test Included Lipid Profile Included HgbA1c Included Rapid Strep Test Included Direct Primary Care Services continued: Additional Services Discount Prescription Card Included Prescription Savings Portal Included Discount Mail Order Prescription Program Included Specialty Care Triage/Support Included *Availability of lab services varies per clinic. **Each clinic offers some form of telemedicine, check with your clinic selection for their method. PATIENT AGREEMENT ACKNOWLEDGEMENT I, the Patient, authorize signature by electronic means to this Direct Primary Care Agreement and any other documents or instruments that may be provided to me during enrollment or thereafter. By affixing my electronic signature to this Direct Primary Care Agreement during enrollment, I acknowledge and agree that: (a) I have read this Direct Primary Care Agreement; and, (b) prior to enrollment I had an opportunity to discuss any questions I may have had about the terms contained within this Direct Primary Care Agreement with the Provider. Further, I have the right to have this Direct Primary Care Agreement provided or made available on paper or in non-electronic form at no additional fee to me. I may update my electronic contact information or withdraw consent at any time of the use of my electronic signature by contacting EverMed at the address, phone number or email in Section 10 above.
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Direct Primary Care Services. Medical Services Medical Services under this agreement are those medical services that the Physician is permitted to perform under the laws of the State of Missouri, are consistent with Physician’s training and experience, are usual and customary for a family medicine physician to provide, and include the following: • Acute and Non-acute Office Visits • Chronic Disease Management • Blood Pressure Monitoring and Management • Diabetic Monitoring and Management • Breathing Treatments • At the Physician’s discretion, additional services may be offered for an additional fee. Patient is responsible for all costs associated with any procedure, laboratory testing, and specimen analysis unless he/she has signed up for a higher tier of service. The Patient is entitled to a personalized, annual in-depth “wellness examination and evaluation,” which shall be performed by the Physician, and may include the following, as appropriate: • Detailed review of medical, family, and social history and update of medical record; • Personalized Health Risk Assessment utilizing current screening guidelines; • Preventative health counseling, which may include: weight management, smoking cessation, behavior modification, stress management, etc.; • Custom Wellness Plan to include recommendations for immunizations, additional screening tests/evaluations, fitness and dietary plans; • Complete physical exam & form completion as needed (as deemed appropriate and medically necessary by the Physician).
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Direct Primary Care Services 
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Related to Direct Primary Care Services

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • Emergency Care Services If you experience a medical emergency while traveling outside our service area, go to the nearest emergency or urgent care facility. When you receive Out-of-Area covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for the Out-of-Area Covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: • the billed charges for your Out-of-Area covered healthcare services; or • the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.

  • Urgent Care Services All Medically Necessary Covered Services received in Urgent Care Centers, Retail Clinics or your Primary Care Physician’s office after-hours to treat an Urgent Medical Condition will be covered by AvMed. Any request for reimbursement of payment made by a Member for services received must be filed within 90 days or as soon as reasonably possible but not later than one year unless the Member was legally incapacitated. If Urgent Medical Services and Care are required while outside the continental United States, Alaska or Hawaii, it is the Member’s responsibility to pay for such services at the time they are received. For information on filing a Claim for such services, see Part XIII. REVIEW PROCEDURES AND HOW TO APPEAL A CLAIM (BENEFIT) DENIAL.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • Prevention Care Services and Early Detection Services See Prevention and Early Detection Services section for details. 0% Not Covered Private Duty Nursing Services* Must be performed by a certified home health care agency. 0% - After deductible Not Covered

  • Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received: • as an inpatient; • as an outpatient; • in your home; • in a doctor’s office; or • from a pharmacy. Also coverage differs depending on whether: • the health care provider is a network provider or non-network provider; • deductibles (if any), copayments, or maximum benefit apply; • you have reached your plan year maximum out-of-pocket expense; • there are any exclusions from coverage that apply; or • our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.

  • Core Services The Company agrees to provide those Core Services to the Municipality as set forth in Schedule “A” and further agrees to the process contained in Schedule “A”.

  • Software Services If elected by Customer, the following Software Services will be made available for Customer’s use.

  • Collection Services 5.01 General 5-1 5.02 Solid Waste Collection 5-1 5.03 Targeted Recyclable Materials Collection 5-3

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