Home Health Care Benefits Sample Clauses

Home Health Care Benefits. Benefits are provided for home health care ser- vices from a Participating home health care agency when the services are ordered by the Member’s Physician, and included in a written treatment plan. Services by a Non-Participating home health care agency, shift care, private duty nursing and stand- alone health aide services must be prior authorized by Blue Shield. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers will be payable up to a combined per Member per Calendar Year visit maximum as shown on the Summary of Bene- fits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maximum (including all home health visits) by any of the following professional providers:
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Home Health Care Benefits. The Plan covers charges for home health care made by a Home Health Care Agency, provided that the Home Health Care Plan: • Is prescribed by a Physician; • Is reviewed and approved by the Physician every two weeks; and • Contains a statement expressing the belief of the Physician and Home Health Care Agency that the: − Number of days of home health care does not exceed the number of days of confinement in a Hospital or nursing home that would have been required; − Home health care will cost less per day than the daily rate for confinement in a Hospital or nursing home; and − Confinement in a Hospital or nursing home would otherwise be required. Home health care does not include housekeeping or custodial care. The Plan covers TMJ expenses for surgical procedures only. The MAP is administered by an organization of medical psychologists, social workers, and counselors who provide confidential professional assistance. A copy of the Home Health Care Plan must be provided to the agency. Home health care includes: • Skilled nursing care and home health aide services; and • Any other services and supplies provided instead of the services, which would have been covered under the Plan, if the Employee were confined in a Hospital or nursing home. The Plan provides dental benefits in certain circumstances, including: • Charges for the surgical extraction of impacted wisdom teeth and related anesthesia administered for the procedure. • Dental services for the treatment of an Injury to the jaw or natural teeth, including X-rays, within six months. These services will be covered the same as for medical expenses related to an accident/Injury. The Plan covers TMJ expenses if the covered individual is advised by a Physician or surgeon to have a surgical procedure performed for the treatment of temporomandibular joint (TMJ) dysfunction, including associated myofacial repair, mandibular or maxillar osteototomy or any related surgery. However, the Fund requires that the individual obtain a second surgical opinion. The Fund will pay 100% of the expenses incurred for such second surgical opinion relating to the Medical Necessity for surgery (including x-rays and laboratory services) and no Plan deductibles will apply. The Physician or surgeon rendering the second surgical opinion may be chosen by the covered individual, provided the Physician or surgeon satisfies the conditions listed in the following “Confirming TMJ Surgical Treatment” section. No benefits are payable for any TM...
Sample 1
Home Health Care Benefits. Benefits are provided for home health care ser- vices when ordered and authorized through the Member’s Primary Care Physician. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers are covered up to the combined per Member per Calendar Year visit maximum as shown on the Summary of Ben- efits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maxi- mum. The visit maximum includes all home health visits by any of the following professional providers:
Sample 1
Home Health Care Benefits. Home health care agency services (Including home visits by a nurse, home health aide, medical social worker, physical therapist, speech therapist or occupational thera- pist) Up to a maximum of 100 visits per Member, per Calendar Year, by home health care agency providers. If your benefit Plan has a Calendar Year Medical Deductible, the number of visits starts counting toward the maximum when services are first provided even if the Calendar Year Medical Deductible has not been met. $20 per visit Medical supplies You pay nothing Hemophilia home infusion services Services provided by hemophilia infusion providers and prior au- thorized by Blue Shield. Includes blood factor product. You pay nothing
Sample 1
Home Health Care Benefits. Benefits are provided for home health care ser- vices when ordered and authorized through the Member’s Primary Care Physician. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers are covered up to the combined per Member per Calendar Year visit maximum as shown on the Summary of Ben- efits. Injectable Therapy Benefit or under the Supplemen- tal Benefit for Outpatient Prescription Drugs if se- lected as an optional Benefit by your Employer. Skilled services provided by a home health agency are limited to a combined visit maximum as shown in the Summary of Benefits per Member per Calen- dar Year for all providers other than Plan Physicians. See the Hospice Program Benefits section for in- formation about admission into a Hospice program and specialized Skilled Nursing services for Hos- pice care. For information concerning diabetic self-manage- ment training, see the Diabetes Care Benefits sec- tion. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maxi- mum. The visit maximum includes all home health visits by any of the following professional providers:
Sample 1
Home Health Care Benefits. Services Provided at a Non-Plan Hospital Following Stabilization of an Emergency Medical Condition
Sample 1
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Home Health Care Benefits. Benefits are provided for home health care ser- vices from a Participating home health care agency when the services are ordered by the Member’s Physician, and included in a written treatment plan. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers will be payable up to a combined per Member per Calendar Year visit maximum as shown on the Summary of Bene- fits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maximum (including all home health visits) by any of the following professional providers:
Sample 1
Home Health Care Benefits. In-Network, the Medical Plan shall pay ninety percent (90%) of expenses for up to sixty (60) home health care visits per calendar year, after $50 of the $200 deductible has been satisfied. Out-of-Network, the Medical Plan shall pay seventy percent (70%) of expenses for up to sixty (60) home health care visits per calendar year, after the full deductible has been satisfied.
Sample 1

Related to Home Health Care Benefits

  • Health Care Benefits A. Each regular, full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans: 1. Blue Cross/Blue Shield of Michigan Flexible Blue 3 with Flexible Blue Rx Prescription Drug Coverage with a Health Savings Account (hereinafter collectively referred to as the “H.S.A Plan”). The Employer shall pay for the illustrated premium cost of this coverage and make an annual contribution to each participating employee’s Health Savings Account in the amount of $500 for those selecting single coverage and $1,000 for those selecting Employee & Spouse, Employee Child(ren) or Family coverage, or the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the lesser Employer contribution to the cost of such plan. Employees may, at their option, make additional contributions through bi-weekly pre-tax payroll deduction as permitted by applicable law. 2. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 3 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution. 3. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 6 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution. (a) All coverage under any of the foregoing plans shall be subject to such terms, conditions, exclusions, limitations, deductibles, co-payments premium cost-sharing, and other provisions of the plans. Coverage shall commence on the employee’s ninetieth (90th) day of continuous employment. The employee’s contribution to the cost of such coverage shall be payable on a bi-weekly basis through automatic payroll deduction. (b) To qualify for health care benefits as above described each employee must individually enroll and make proper application for such benefits at the Human Resources Department upon the commencement of his regular employment with the Employer. (c) Except as otherwise provided under the Family and Medical Leave Act, when on an authorized unpaid leave of absence of more than two weeks, the employee will be responsible for paying all his benefit costs for the period he is not on the active payroll. Proper application and arrangements for the payment of such continued benefits must be made at the Human Resources Department prior to the commencement of the leave. If such application and arrangements are not made as herein described, the employee's health care benefits shall automatically terminate upon the effective date of the unpaid leave of absence. (d) Except as otherwise provided under this Agreement and/or under COBRA, an employee's health care benefits shall terminate on the date the employee goes on a leave of absence for more than two weeks, terminates, retires or is laid off. Upon return from a leave of absence or layoff, an employee's health care benefits coverage shall be reinstated commencing with the employee's return. (e) An employee who is on layoff or leave of absence for more than two weeks or who terminates may elect under COBRA to continue the coverage herein provided at his own expense. (f) The Employer reserves the right to change a carrier(s), a plan(s), and/or the manner in which it provides the above benefits, provided that the benefits and conditions are equal to or better than the benefits and conditions outlined above. (g) To be eligible for health care benefits as provided above, an employee must document all coverage available to him under his spouse's medical plan and cooperate in the coordination of coverage to limit the Employer's expense. If an employee’s spouse or eligible dependent children work for an employer who provides medical coverage, they are required to elect medical coverage with their employer, so long as the spouse’s or monthly contribution to the premium does not exceed 20% of the total premium cost of said coverage. The Monroe County Plan shall provide secondary coverage. (h) Each employee is responsible for notifying the Human Resources Department of any change in his status, which might affect his insurance coverage or benefits, such as, marriage, divorce, births, adoptions, deaths, etc.

  • Extended Health Care Benefits The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended.

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Health & Welfare Benefits Executive shall be eligible to participate in all health and welfare benefits provided generally to other employees of the Company.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for 130 workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this Section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Personnel Commission.

  • Health and Welfare Benefits applies to full-time nurses only)

  • Retiree Health Benefits 1. There is currently in effect a retiree health benefit program for retired members of LACERS under LAAC Division 4, Chapter 11. All covered employees who are members of LACERS, regardless of retirement tier, shall contribute to LACERS four percent (4%) of their pre-tax compensation earnable toward vested retiree health benefits as provided by this program. The retiree health benefit available under this program is a vested benefit for all covered employees who make this contribution, including employees enrolled in LACERS Tier 3. 2. With regard to LACERS Tier 1, as provided by LAAC Section 4.1111, the monthly Maximum Medical Plan Premium Subsidy, which represents the Kaiser 2-party non-Medicare Part A and Part B premium, is vested for all members who made the additional contributions authorized by LAAC Section 4.1003(c). 3. Additionally, with regard to Tier 1 members who made the additional contribution authorized by LAAC Section 4.1003(c), the maximum amount of the annual increase authorized in LAAC Section 4.1111(b) is a vested benefit that shall be granted by the LACERS Board. 4. With regard to LACERS Tier 3, the Implementing Ordinance shall provide that all Tier 3 members shall contribute to LACERS four percent (4%) of their pre-tax compensation earnable toward vested retiree health benefits, and shall amend LAAC Division 4, Chapter 11 to provide the same vested benefits to all Tier 3 members as currently are provided to Tier 1 members who make the same four percent (4%) contribution to LACERS under the retiree health benefit program. 5. The entitlement to retiree health benefits under this provision shall be subject to the rules under LAAC Division 4, Chapter 11 in effect as of the effective date of this provision, and the rules that shall be placed into LAAC Division 4, Chapters 10 and 11, with regard to Tier 3, by the Implementing Ordinance. 6. As further provided herein, the amount of employee contributions is subject to bargaining in future MOU negotiations. 7. The vesting schedule for the Maximum Medical Plan Premium Subsidy for employees enrolled in LACERS Tier 1 and LACERS Tier 3 shall be the same. 8. Employees whose Health Service Credit, as defined in LAAC Division 4, Chapter 11, is based on periods of part-time and less than full-time employment, shall receive full, rather than prorated, Health Service Credit for periods of service. The monthly retiree medical subsidy amount to which these employees are entitled shall be prorated based on the extent to which their service credit is prorated due to their less than full time status.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

  • Retiree Health Insurance Retired members of the Department receiving, or to receive City of Lincoln monthly pension checks, may participate in the group comprehensive health care plan for active City employees, provided that each retiree so desiring will execute the required forms in a timely fashion, and further provided that each retiree will be required to pay the full monthly cost at the current rates subject to any rate increases which may occur from time to time. Such payment will be made by payroll deduction from pension checks, or by direct payment in the case of an early retiree.

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