Emergency Prescriptions Sample Clauses

Emergency Prescriptions. Emergency prescriptions are covered subject to the following terms: When a Member needs a prescription filled in an emergency or Urgent Care situation, or when the Member is traveling outside of the HMO Service Area, HMO will reimburse the Member as described below. When a Member obtains an emergency or out-of-area Urgent Care prescription at a non- Participating Retail Pharmacy, Member must directly pay the pharmacy in full for the cost of the prescription. Member is responsible for submitting a request for reimbursement in writing to HMO with a receipt for the cost of the prescription. Reimbursement requests are subject to professional review by HMO to determine if the event meets HMO’s requirements. Upon approval of the claim, HMO will directly reimburse the Member 100% of the cost of the prescription, less the applicable Copayment specified below and any Brand Name Prescription Drug cost differentials as applicable. Coverage for items obtained from a non-Participating pharmacy is limited to items obtained in connection with covered emergency and out-of-area Urgent Care services. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area. When a Member obtains an emergency or Urgent Care prescription at any Participating Retail Pharmacy, including an out-of-area Participating Retail Pharmacy, Member will pay to the Participating Retail Pharmacy the Copayment(s), plus the Brand Name Prescription Drug cost differentials where applicable and as described below. Members are required to present their ID card at the time the prescription is filled. HMO will not cover claims submitted as a direct reimbursement request from a Member for a prescription purchased at a Participating Retail Pharmacy except upon professional review and approval by HMO in its sole discretion. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area.
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Emergency Prescriptions. Emergency prescriptions are covered subject to the following terms: When a Member needs a prescription filled in an emergency or Urgent Care situation, or when the Member is traveling outside of the HMO Service Area, HMO will reimburse the Member as described below. When a Member obtains an emergency or out-of-area Urgent Care prescription at a non- Participating Retail Pharmacy, Member must directly pay the pharmacy in full for the cost of the prescription. Member is responsible for submitting a request for reimbursement in writing to HMO with a receipt for the cost of the prescription. Reimbursement requests are subject to professional review by HMO to determine if the event meets HMO’s requirements. Upon approval of the claim, HMO will directly reimburse the Member 100% of the cost of the prescription, less the applicable Copayment specified below and any Brand Name Prescription Drug cost differentials as applicable. Coverage for items obtained from a non-Participating pharmacy is limited to items obtained in connection with covered emergency and out-of-area

Related to Emergency Prescriptions

  • Emergency Preparedness All residents are advised to have an emergency plan. It is recommended that each resident maintain an emergency supply kit consisting of a first aid kit, three-day supply of water, non-perishable food, battery operated radio and flashlight, extra batteries, portable electronic device charger, gloves, and medications.

  • Emergency Precautions Forest Service may require the necessary shutting down of equipment on portions of Purchaser’s Operations, as specified by the emergency fire precautions schedule of C7.22. Under such conditions, after Purchaser ceases active opera- tions, Purchaser shall release for hire by Forest Service, if needed, Purchaser’s shutdown equipment for fire standby on Sale Area or other areas of Purchaser’s Operations and personnel for fire standby or fire patrol, when such personnel and equipment are not needed by Purchaser for other fire fighting or protection from fire. Equipment shall be paid for at fire fighting equipment rates common in the area or at prior agreed rates and, if Purchaser re- quests, shall be operated only by personnel approved by Purchaser. Personnel so hired shall be subject to direc- tion and control by Forest Service and shall be paid by Forest Service at fire fighting rates common in the area or at prior agreed rates.

  • Frequency Protection Should Company install any type of radio transceiver or other wireless communications equipment, Company will provide frequency protection within the aviation air/ground VHF frequency band and the UHF frequency band in accordance with restrictions promulgated by the Federal Aviation Administration (FAA) for the vicinity of FAA Transmitter or Receiver facilities. Frequency protection will also be provided for all other frequency bands operating in the vicinity of Company’s equipment. Should interference occur as a result of Company’s installation, Authority reserves the right to shut down Company’s installation until appropriate remedies to the interference are made by Company. Such remedies may include relocation to another site. The cost of all such efforts to remedy the interference will be solely at Company’s expense.

  • Prescriptions and bottles of these medications may be sought by individuals with chemical dependency and should be closely safeguarded. It is expected that you will take the highest possible degree of care with your medication and prescription. They should not be left where others might see or otherwise have access to them.

  • Emergency Procedures a) ENP providers shall have a written Emergency/Disaster Plan.

  • Prescription Drugs The agreement may impose a variety of limits affecting the scope or duration of benefits that are not expressed numerically. An example of these types of treatments limit is preauthorization. Preauthorization is applied to behavioral health services in the same way as medical benefits. The only exception is except where clinically appropriate standards of care may permit a difference. Mental disorders are covered under Section A. Mental Health Services. Substance use disorders are covered under Section

  • Prescription Drug any drugs or medications ordered by a Professional Provider by means of a valid prescription order, bearing the Federal legend: “Caution - Federal law prohibits dispensing without a prescription,” or legend drugs under applicable state law and dispensed by a licensed pharmacist. Also included are prescribed insulin and other pharmacological agents used to control blood sugar, diabetic supplies and insulin syringes.

  • label Prescription Drugs This plan covers off label prescription drugs for cancer or disabling or life-threatening chronic disease if the prescription drug is recognized as a treatment for cancer or disabling or life-threatening chronic disease in accepted medical literature, in accordance with R.I. General Law § 27-55-1.

  • Specialty Prescription Drugs (+ Prorated copayments for a shorter supply period may apply for network pharmacy only. See Prescription Drug section for details. When purchased at a Specialty Pharmacy (+): For maintenance and non-maintenance prescription drugs, a copayment applies for each 30-day period (or portion thereof) within the prescribeddosing period. Tier 5: $125 Not Covered When purchased at a Retail Pharmacy (+): For maintenance and non-maintenance prescription drugs, a copayment applies for each 30-day period (or portion thereof) within the prescribeddosing period. Specialty Prescription Drugs purchasedat a retail pharmacy will require a significantly higher out of pocket expense than if purchased from a Specialty Pharmacy. Our reimbursement is based on the pharmacy allowance. Tier 5: 50% Not Covered When purchased at a Mail Order Pharmacy: Not Covered Not Covered Covered Benefits Network Pharmacy Non-network Pharmacy (+) Preauthorization is required for thisservice. Please see Preauthorization in Section 3 for more information. You Pay You Pay Infertility Prescription Drugs - Three(3) in-vitro cycles will be covered per plan year with a total of eight (8) in-vitro cycles covered in a member’s lifetime. When purchased at a Specialty, Mail Order, or Retail Pharmacy Tier 1: 20% Not Covered Tier 2: 20% Not Covered Tier 3: 20% Not Covered Tier 4: 20% Not Covered When purchased at a Specialty Pharmacy (+) Tier 5: 20% Not Covered When purchased at a Retail Pharmacy (+): Specialty Prescription Drugs purchased at a retail pharmacy will require a significantly higher out of pocket expense than if purchased from a specialty pharmacy. Tier 5: 20% Not Covered Contraceptive Methods- Preventive Coverage includes barrier method (diaphragmor cervical cap), hormonal method (birth control pill), and emergency contraception. For non-preventive contraceptive prescription drugs and devices, the amount you pay will depend on the tier placement of the contraceptive prescription drug or device. See above for details. When purchased at a Retail Pharmacy: Up to a 365-day supply of contraceptive prescription drugs is available at all network retail pharmacies. For more information about this option, visit our website. Tier 1: $0 Not Covered When purchased at a Mail Order Pharmacy: Up to a 90-day supply. Tier 1: $0 Not Covered

  • Prescription Glasses This plan covers prescription glasses as follows: • Frames - one (1) collection frame per plan year; • Lenses - one (1) pair of glass or plastic collection lenses per plan year. This includes single vision, bifocal, trifocal, lenticular, and standard progressive lenses. This plan covers the following lens treatments: • UV treatment; • tint (fashion, gradient, and glass-grey); • standard plastic scratch coating; • standard polycarbonate; and • photocromatic/transitions plastic. Contact Lenses (in lieu of prescription glasses) This plan covers one (1) supply of contact lenses as follows: • conventional contact lenses - one (1) pair per plan year from a selection of provider designated contact lenses; or • extended wear disposable lenses - up to a 6-month supply of monthly or two- week single vision spherical or toric disposable contact lenses per plan year; or • daily wear disposable lenses - up to a 3-month supply of daily single vision spherical disposable contact lenses per plan year. This plan also covers the evaluation, fitting, or follow-up care related to contact lenses. This plan covers additional contact lenses if your prescribing network provider submits a verification form, with the regular claim form, verifying that you have one of the following conditions: • anisometropia of 3D in meridian powers; • high ametropia exceeding -10D or +10D in meridian powers; • keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses; and • vision improvement for members whose vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.

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