Hospital Outpatient Sample Clauses

Hospital Outpatient. Treatment by a Physician or surgeon in the outpatient department of a hospital will be considered up to the Allowable Expense for such treatment.
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Hospital Outpatient. Lab, x-ray, medical equipment, surgical services, and substance abuse.
Sample 1
Hospital Outpatient. Outpatient hospital services at a network hospital will be subject to an $8.00 copayment. Effective June 1, 2005, the copayment will be $15.00. Mammographies and Cervical Cytology Screening. Coverage for cervical cytology screening once each health insurance contract year will be provided subject to the doctor's office limit and either an $8.00 copayment or deductible and coinsurance. Services for the examination of the Pap smear on a different date or at a different location than the office visit will result in a separate $8.00 copayment or deductible and coinsurance. Effective June 1, 2005, the copayment will be $10.00. Coverage will be provided for mammographies according to the guidelines outlined below subject to the doctor's office visit limit and an $8.00 copayment or deductible and coinsurance. Effective June 1, 2005, the copayment will be $10.00.
Sample 1
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.
Sample 1
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Outpatient Rehabilitation (Occupational Therapy, Physical Therapy, Speech Language Pathology)  Covered.  MCO.  Covers Covers physical therapy, occupational Part B. Outpatient evaluation and treatment for occupational, speech language pathology, and physical therapy. physical, therapy, speech Certain conditions and limitations apply. occupational, and pathology, and speech/language cognitive Any applicable cost sharing is covered by therapy. For rehabilitation the Medicaid benefit. Members have $0 FamilyCare B and therapy. cost sharing liability. C beneficiaries, limited to 60 days Covered for per therapy per services calendar year rendered beyond (except for MLTSS Medicare Part B members - refer to benefit limits. Appendix B.9.0).  (N.J.A.C. § See also
Sample 1
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment for medically necessary treatment provided by a doctor. Members also pay a copayment for foot exams related to diabetic peripheral neuropathy rendered in a hospital outpatient setting. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Prescription Drugs (including Medicare Part B and Part D)  Covered.  MCO and FFS Covered for services Part B: All Part B prescription drugs. (coverage differs rendered beyond Part D: Medicare Part D Prescription Drug for each).  Categorically Medicare Part B and Part D coverage is a required benefit for all SNPs. See 42 CFR 422.100(f)(3). Needy.  MCO coverage benefit limits. Includes Any applicable cost sharing is covered by excludes ABD prescription the Medicaid benefit. Members have $0 population and all drugs (legend cost sharing liability. other dual eligible and non-legend beneficiaries.  (N.J.A.C. covered by the Medicaid 10:49-5.2(a)18)  FFS covers program including legend and non- physician legend drugs for administered the ABD drugs); population and all prescription other dual eligible vitamins and beneficiaries.  (N.J.A.C. mineral products (except prenatal 10:49-5.2(b)15)  (N.J.A.C. § vitamins and fluoride) 10:74-3.4(a)2)  For the including, but not limited to, Medically Needy, therapeutic only available to vitamins, such as pregnant women high potency A, and needy D, E, Iron, Zinc, children (Groups A and minerals, and B) or aged, including blind, and disabled potassium, niacin beneficiaries and related residing in products. All Medicaid blood clotting participating factors shall be nursing facilities included in the (not available to list of blood any other ABD clotting factors. group).  (N.J.A.C. The contractor shall continue to 10:49-5.3(a)6) cover physician administered drugs for all enrollees in accordance with the list of applicable codes provided by DMAHS. Includes drugs which may be excluded from Medicare Part D coverage under section 1927(d)(2) referred to in the Medicare Modernization Act 2003. $0 cost-share for beneficiaries. Physician Services - Primary and Specialty Care  Covered. Covered for services rendered beyond Medicare Part B benefit limits. Part B. Covers medically necessary services and certain preventive services in outpatient settings. Physician services covered by Part B in some inpatient settings. Any applicable cost sharing is covered by the Medicaid benefit. Member...
Sample 1
Hospital Outpatient. The member pays a copayment for digital rectal exams in a hospital outpatient setting. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.
Sample 1
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Hospital Outpatient. Plan will pay Provider at the then current Indiana Medicaid rates and methodology or its successor, less applicable Copayments.
Sample 1
Hospital Outpatient. Projected PMPM and Actual PMPM shall include claims costs for hospital outpatient facilities only for those categories of services subject to CareAdvantage review activities, i.e., ambulatory surgery, home health care, home infusion, and observation room. Hospital outpatient claims costs shall exclude claims costs incurred for mental health, substance abuse and ancillary services not provided in conjunction with those categories of services subject to CareAdvantage review activities, maternity-related services and ITS claims, as well as professional fees. Any other inclusions or exclusions will be prospectively agreed upon by the parties.
Sample 1

Related to Hospital Outpatient

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Hospital This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Inpatient If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section

  • Hospice Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the service areas of the health plans participating in Advantage. If these individuals use the plan administrator’s national preferred provider organization in their area, services will be covered at Benefit Level Two. If a national preferred provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph “i” below. All terms and conditions outlined in the Summary of Benefits will apply.

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias.

  • Medical There shall be an open enrollment period for medical coverage in each year of this Agreement. An employee may elect no medical coverage during any open enrollment period. An employee who has elected no medical coverage may elect medical coverage during an open enrollment period. No pre-existing condition limitations will apply.

  • Prosthodontics We Cover prosthodontic services as follows:

  • Ambulance The deductible and coinsurance for services not subject to copays applies.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

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