Hospital Benefits. This section of your Certificate explains what your benefits are when you re ceive care in a Hospital or other eligible health care facility. Benefits are only available for services rendered by a Hospital unless another Provider is specifi cally mentioned in the description of the service. Remember, to receive benefits for Covered Services, (except for Mental Illness other than Serious Mental Illness), they must be ordered or approved by your Primary Care Physician or Woman's Principal Health Care Provider. Whenever we use “you” or “your” in describing your benefits, we mean all xxx gible family members who are covered under Family Coverage.
Hospital Benefits. Covered service expenses are limited to charges made by a hospital for:
Hospital Benefits. Care In a Hospital You are covered for medically necessary care as an inpatient in a Hospital if all the following conditions are met:
Hospital Benefits. Any self-insured or otherwise unregulated health plan will offer at least the following hospital benefits:
1. Unlimited duration of benefits
2. Semi-Private Room
3. Hospital Ancillary Services
4. Other Charges There is a $25 charge for the use of the emergency room which does not result in an admission. Effective July 1, 2003 the Emergency Room co-pay will increase to $50. Effective July 1, 2004 the Emergency Room co-pay will increase to $75. If there is a penalty charge established by the Department of Administrative Services for the non-emergency use of a non-network hospital, it shall be no greater than $250. Effective July 1, 2003 the penalty shall be increased to $350.
5. Diagnostic X-ray and Laboratory Tests For pre-admission tests, eighty percent (80%) when using a network hospital; sixty percent (60%) of UCR/Allowed Amount when using a non-network hospital. For all others, when using a network hospital, eighty percent (80%) of charges. When using a non-network hospital, sixty percent (60%) of UCR/Allowed Amount. Deductibles apply. One hundred percent (100%) coverage after OPM is reached.
6. All Other Necessary Treatments and Procedures When using a network hospital, eighty percent (80%) of charges. When using a non-network hospital sixty percent (60%) of UCR/Allowed Amount. Deductibles apply. One hundred percent (100%) coverage after OPM is reached. However, note that some limitations and exclusions may apply. See 20.06 (E) above.
Hospital Benefits. Coverage is provided for the hospital's additional charge for a semi-private room in any Manitoba hospital (the Government plan covers standard xxxx charges) and payment for additional semi-private charges by hospitals outside Manitoba at the rate in effect at that time in the Province of Manitoba. If a subscriber requires diagnostic testing or treatment, on the recommendation of a medical practitioner, at a Manitoba hospital located more than 60 kilometres from the subscriber's home, and if the subscriber is placed in a recognized medical hostel associated with the hospital, Blue Cross will pay the reasonable and customary per diem charge for such hostel accommodation. In addition, the Extended Health Benefits Plan shall pay for 80% of eligible health care services listed below subject to the terms and conditions of the contract. Accidental Dental Treatment Required as a result of accidental injury where natural teeth have been damaged or broken or a dislocated jaw requires setting. Treatment must start within 90 days of the accident. Athletic Therapy Services rendered by a Certified Athletic Therapist. $100 Breast Prosthesis and Surgical Bras Upon the written prescription of a physician. $350 Cardiac Rehabilitation For cardiac patients when prescribed by the attending physician after myocardial infarction, coronary bypass surgery, or valve replacement or for the management of angina pectoris or other diagnosed cardiac disease. $350 Chiropractic Services rendered by a Chiropractor. $350 Clinical Psychology Charges of a registered Clinical Psychologist. $350 Hearing Aids Purchase or repair when prescribed by an Otologist or Audiologist. (charges for regular maintenance, batteries or recharging devices are not eligible) $1,000 during any 5 consecutive year period Massage Therapy Services rendered by a licensed Massage Therapist. $350 Nutrition Counseling Services provided by a registered dietician when you are referred by a physician. $350 Orthotics When prescribed by a physician, physiotherapist, or podiatrist. $350 Physiotherapy Diagnosis and treatment by licensed Physiotherapist. (excludes diagnostic x-rays and examinations) $350 Podiatry Diagnosis and treatment by licensed Podiatrist. (excludes diagnostic x-rays and examinations) $350 Private Duty Nursing Services provided in a hospital by a professional nurse (not an employee of the hospital) when recommended by a physician. Charges for nursing visits in the home of the subscriber by a professional nur...
Hospital Benefits. The plan will pay 100% of the following charges:
Hospital Benefits. The plan provides for reimbursement for one hundred per cent (100%) of the cost for a semi-private room.
Hospital Benefits. (a) Effective April 1, 1961 room and board maximum will be twenty dollars ($ 20 .00 ) per day for a maximum of one hundred twenty (120) days.
(b) Other hospital charges unlimited during one hundred twenty ( 120) day period.
(c) Maternity benefits: Up to twenty dollars ($20 .00 ) per day plus full reimbursement of other hospital charges for eight ( 8 ) days for normal delivery, ten (10) days for Caesarean sec tion. Benefits available after nine (9) months of coverage as provided in the policy.
Hospital Benefits. Payable for Room and Board 365 days, semi-private accommodations in accordance with PPO Extra Hospital Charges Paid in accordance with PPO Emergency Out-Patient Coverage Paid in accordance with PPO (within 24 hours) Out-Patient Surgery Paid in accordance with PPO Intensive Care Paid in accordance with PPO UCR stands for usual, customary and reasonable charges. -$500 Individual/$1,000 Family, with cross application for single or family for out-of-network services. to a maximum of $500/person with no cross application, excluding deductibles for in-network services and ninety percent (90%) of covered expenses, up to a maximum of Insurance pays 70% of covered expenses up to a maximum of $2,000/person with no cross application, excluding deductibles for out-of-network services and seventy percent (70%) of covered expenses up to a maximum of A Tier II Catastrophic insurance plan will be offered at no cost to the employee as an alternative to electing Tier I coverage. -$6,000 individual/$10,000 family, with cross application for single or family for out-of-network services. of $6,000/person with no cross application, excluding deductibles for in-network services and sixty percent (60%) of covered expenses, up to a maximum of $10,000/family. Insurance pays 50% of covered expenses up to a maximum of $10,000/person with no cross application, excluding deductibles for out-of-network services and 50% of covered expenses up to a maximum of $14,000/family.
Hospital Benefits i. Hospital Care - payment of differential charges of $8.00 per day for semi-private and $16.00 per day for private beds in public general active treatment hospitals.
ii. An allowance of up to $400.00 for each participant in a benefit year towards the cost of accommodation in an auxiliary hospital.
iii. Out-patient expenses
iv. Hospital care allowance of up to $150.00 per day outside the province of residence.
