Eligible Medical Expenses. Amounts paid by a Participant while the Participant is participating in this Plan, and which are paid for medical expenses authorized under Code Section 213(d) (including eligible over-the-counter medications). Medical expenses paid or reimbursed by (1) any insurance policy or policies, whether owned by the Employer or the Participant, or (2) any federal or state health or accident plan, shall not be eligible for reimbursement under this Plan. Notwithstanding the foregoing, Eligible Medical Expenses for Participants who participate in this Plan for a limited purpose (that is, Participants who participate in an HSA) are such expenses as are within the coverage permitted under Code Section 223, and written guidance promulgated pursuant thereto, including Rev. Rul. 2004-45. As such, a Participant in the Plan may elect to reduce salary for the purpose of paying Eligible Medical Expenses, including dental and vision expenses, and any other permitted expenses; provided further, that after the minimum deductible under the high deductible health plan (as required by Code Section 223(c)(2)(A)) in which the Participant participates is satisfied, all Eligible Medical Expenses subsequently incurred may be reimbursed to the extent of the Benefit elected by the Participant.
Eligible Medical Expenses. Medical expenses for medical treatment required because of athletic related injuries and provided or prescribed by a legally qualified physician,paraprofessional or hospital, provided the medical expense is incurred within 104 weeks after the date of injury. Protective devices, equipment, or clothing used solely during practice or competition and for the purpose of preventing further injury or aggravation to an existing injury, are not covered under this policy. Expense for travel, other than by a professional ambulance service, is not covered. NMU is not responsible for medical payments related to a pre-existing injury or condition or complications associated with a pre-existing injury or condition. General medical conditions that result from direct participation in varsity athletic activity (eg: swimmers ear) Orthotics/Orthotic evaluation Vision injury that occurs as a direct result of participation in organized varsity athletic activity (practice, game, conditioning, weight training) General injury/illness not relations to participation in athletics (includes injections such as immunizations, allergy/flu shots) Chiropractic evaluation/care General injury/illness that occurs in athletic activity outside of organized varsity athletic activity (intramurals, club sports) Pre-existing Injury/Condition and complications of such.
Eligible Medical Expenses. The Policy covers the following eligible services and supplies provided to you or your covered family members. However, the Policy covers only those services and supplies which were medically necessary and only up to reasonable and customary charges, subject to additional restrictions and limitations set forth below and in the Policy: COVERED SERVICES LIMITATIONS AND RESTRICTIONS Acupuncture In lieu of anesthesia only Ambulance Transportation To and from the nearest facility that can give necessary treatment Ambulatory Surgery Pre-Certification required Anesthesia Assistant Surgeon Benefits not payable for hospitals where surgical assistant is routinely available Birthing Center Benefits not to exceed those otherwise available for pregnancy under the Policy Blood or Blood Plasma Must not be replaced on behalf of the eligible person Cardiac Rehabilitation Pre-Certification required Services Chiropractic Care Pre-Certification required; CHI pays up to a maximum benefit amount of $1,000 per calendar year for detection and correction by manual means of structural imbalance or o subluxation resulting from or related to distortion, misalignment or subluxation of or in the vertical column Consultation Only for consultation requested by the attending physician and given while confined as an in-patient Diagnostic Services Durable Medical Equipment Pre-Certification required on items leased or purchased for more than $1,500 Emergency Services Notification must be made within 24 hours of any admission or as soon thereafter as reasonably possible; Emergency services must be received within 48 hours after the onset of the medical emergency Hemodialysis Home Health Services Pre-Certification required One visit per day; up to 4 hours constitute 1 home health care visit; Hospice Care Pre-Certification required; Maximum individual lifetime benefit of $10,000; Attending physician must certify that the covered person is terminally ill and must recommend admission into a hospice care program Hospital Outpatient Care: Pre-Certification required Inpatient Care: Pre-Certification required (Room & Board at Semi-Private Room Rate*) *Unless Private Room is Medically Necessary Immunization for No deductible and no co-insurance; Children Limited to minimum benefits mandated by the Department of Insurance Infertility Services to diagnose infertility only; Does not cover infertility treatment Inpatient Physician While confined as an inpatient in a hospital Services or skilled nursing f...
Eligible Medical Expenses. The phrase “Eligible Healthcare Expense” means any expense incurred by a Participant or any of his Dependents during a Plan Year that (i) qualifies as a medical care expense under Code Section 213 and/or Revenue Ruling 2003- 102 and meets the requirements outlined in Section 125 and its regulations, (ii) is excluded from gross income of the Participant under Code Section 10 (b), and (iii) has not been, and will not be paid or reimbursed by any other insurance plan, though damages, from any other source, provided, however, that no medical care expense shall be reimbursed unless the treatment giving rise to the expense is prescribed by a licensed practitioner of the healing arts in the State in which the treatment is provided. In addition, a medical care expense incurred by a Participant or the Participant’s Dependent(s) prior to the date such Participant commenced participation in the Medical Reimbursement Plan shall not constitute an Eligible Medical Expense.
Eligible Medical Expenses
