Emergency and Urgent Care Sample Clauses

Emergency and Urgent Care. Emergency Room After annual Part B deductible – 80% coverage of Medicare eligible expenses for the facility and doctor charges (co-insurance/co-payment waived if admitted within 1-3 days of the emergency room visit). Not covered outside the United States except under limited circumstances. Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Urgi-Centers After annual Part B deductible – 80% coverage of Medicare eligible expenses for the doctor charges. Not covered outside the United States except under limited circumstances (this is not emergency care, and in most cases, is out of the service area). Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Inpatient Services Hospitalization Member must pay the inpatient hospital deductible and co-payment for each benefit period for Medicare eligible expenses. A benefit period begins the day the member is admitted into a hospital or skilled nursing facility. The benefit period ends when member has not received hospital or skilled nursing care for 60 days in a row. If member goes into hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods a member can have. Days 1-60: an initial deductible of $792 (inpatient deductible). Days 61-90: $198 co-payment each day. Days 91-150 (reserve days): $396 co-payment each day. (The 60 lifetime reserve days can only be used once).) Plan 65 will pay for the inpatient hospital deductible and the co-payment for Medicare eligible expenses. Upon exhaustion of all Medicare Hospital inpatient coverage including the lifetime reserve days, member is covered up to 90% of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days. Skilled Nursing Care and custodial care are not covered. Days 1-60: an initial deductible of $792 (inpatient deductible). Days 61-90: $198 co-payment each day. Days 91-150: (reserve days): $396 co- payment each day. (The 60 lifetime reserve days can only be used once.) M/M Not applicable. Skilled Nursing Member is responsible for each hospitalization benefit period, following at least 3-day covered hospital stay. There is a limit of 100 days for each benefit period. Must be a Medicare certified skilled nursing facility to receive...
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Emergency and Urgent Care. The copay for In Network urgent care center visits will be $20. The copay for In Network hospital emergency room visits will be $100. There will be no charge for In Network ambulance services, if medically necessary. The coinsurance for Out of Network emergency room, urgent care, and ambulance services will be 20% of the allowed benefit, after the Out of Network annual deductible. Diagnostic, X-ray, and Laboratory Services: The copay for In Network diagnostic services, x-rays, and laboratory tests will be $10. The copay for allergy shots, as well as physical, occupational, and speech therapy will be $20. The copay for In Network chiropractor services will be $30. The coinsurance for Out of Network diagnostic, x-ray, and laboratory services will be 20% of the allowed benefit, after the Out of Network annual deductible.
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Emergency and Urgent Care. Provider agrees to abide by the terms of the State Contract for the timely provision of emergency and urgent care. Where applicable, Provider agrees to follow those procedures for handling urgent and emergency care cases stipulated in any required hospital/emergency room MOUs signed by United in accordance with the State Contract.
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Emergency and Urgent Care. Emergency Room After annual Part B deductible – 80% coverage of Medicare eligible expenses for the facility and doctor charges (co-insurance/co-payment waived if admitted within 1-3 days of the emergency room visit). Not covered outside the United States except under limited circumstances. Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Urgi-Centers After annual Part B deductible – 80% coverage of Medicare eligible expenses for the doctor charges. Not covered outside the United States except under limited circumstances (this is not emergen- cy care, and in most cases, is out of the service area). Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due.
Sample 1
Emergency and Urgent Care. Emergency Care provided by Provider shall be available to Covered Persons twenty-four (24) hours, seven (7) days a week. Urgent care services shall be provided within forty-eight (48) hours of receipt of the request for Urgent Care services.
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Emergency and Urgent Care. The PO is responsible to provide care according to the requirements in 42 C.F.R. § 460.100.
Sample 1

Related to Emergency and Urgent Care

  • Emergency and urgently needed care outside the service area Professional services of a physician, emergency room treatment, and inpatient hospital services are covered at eighty percent (80%) of the first two thousand dollars ($2,000) of the charges incurred per insurance year, and one-hundred percent (100%) thereafter. The maximum eligible out-of-pocket expense per individual per year for this benefit is four hundred dollars ($400). This benefit is not available when the member’s condition permits him or her to receive care within the network of the plan in which the individual is enrolled.

  • Emergency Medical Care a. How to appropriately use Emergency Services and facilities, including a description of the services offered by the Member Services Call Center;

  • Urgent Care This plan covers services received at an urgent care center. For other services, such as surgery or diagnostic tests, the amount that you pay is based on the type of service being provided. See Summary of Medical Benefits for details. Follow-up care (such as suture removal or wound care) should be obtained from your primary care provider or specialist.

  • Emergency Services The parties recognize that in the event of a strike or lockout, situations may arise of an emergency nature. To this end, the Employer and the Union will agree to provide services of an emergency nature.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Emergency Care If you need emergency care, call 911 or go to the nearest hospital emergency room. If you are traveling outside our service area and need urgent care, call the Customer Service number provided in the chart above or visit our website and use the “Find A Doctor” feature to find a BlueCard provider.

  • Emergency Services Leave 6.17.1 Subject to operational requirements, paid leave of absence shall be granted by the Employer to an Employee who is an active volunteer member of State Emergency Service, St Xxxx Ambulance Brigade, Volunteer Fire and Rescue Service, Xxxx Fire Brigades, Volunteer Marine Rescue Services Groups or FESA Units, in order to allow for attendances at emergencies as declared by the recognised authority.

  • 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.

  • Emergency Childcare Employees may use vacation leave for childcare emergencies after the employee has exhausted all of their accrued compensatory time. Use of vacation leave and sick leave for emergency childcare is limited to a combined maximum of four (4) days per calendar year.

  • Emergency Management The plan shall also address the assumption of operations of the program or facility by Department in the event of Contractor's bankruptcy or financial insolvency or if Contractor is unable to operate the facility.

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