Hospital Services. The Hospital will:
6.1.1 achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specifications;
6.1.2 not reduce, stop, start, expand, cease to provide or transfer the provision of Hospital Services to another hospital or to another site of the Hospital if such action would result in the Hospital being unable to achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specifications; and
6.1.3 not restrict or refuse the provision of Hospital Services that are funded by the Funder to an individual, directly or indirectly, based on the geographic area in which the person resides in Ontario, and will establish a policy prohibiting any health care professional providing services at the Hospital, including physicians, from doing the same.
Hospital Services. Non-Emergency inpatient hospital services require Preauthorization. Refer to Section IV. for more information about hospital services.
Hospital Services. Employer and Employee acknowledge that, as of the date hereof, Employer does not currently operate hospitals, hospital systems or universities. Nevertheless, the businesses of hospitals, hospital systems and universities would be the same as Employer’s Business where such hospitals, hospital systems or universities provide or contract with others to provide some or all of the medical services included in Employer’s Business. Therefore, the parties desire to clarify their intent with respect to the limitations on Employee’s ability to work for or contract with others to provide services for a hospital, hospital system or university during the Employment Period and during the Restricted Period.
Section 8.1 shall not be deemed to restrict Employee’s ability to work for a hospital, hospital system or university if the hospital, hospital system or university does not provide any of the medical services included in Employer’s Business. Furthermore, even if a hospital, hospital system or university provides medical services that are included in Employer’s Business, Employee may work for such hospital, hospital system or university if Employee has no direct supervisory responsibility for or involvement in the hospital’s, hospital system’s or university’s medical services that are Employer’s Business. Finally, Employer agrees that Employee may hold direct supervisory responsibility for or be involved in the medical services of a hospital, hospital system or university that are included in Employer’s Business so long as such hospital, hospital system or university is located at least ten (10) miles from a medical practice owned or operated by Employer or its affiliate. Subject to paragraph B below, the provisions of this paragraph shall not apply to the extent that, after the date hereof, Employer enters into the business of operating a hospital or hospital system.
Hospital Services. This plan covers services you get in a hospital. At an in-network hospital, you may get services from doctors or other providers who are not in your network. When you get covered services from non-contracted providers, you pay any amounts over the allowed amount. Covered services include: Room and board, general duty nursing and special diets Doctor services and visits Use of an intensive care or special care units Operating rooms, surgical supplies, anesthesia, drugs, blood, dressing, durable medical equipment and oxygen X-ray, lab and testing Covered services include: Operating rooms, procedure rooms and recovery rooms Doctor services Anesthesia Services, medical supplies and drugs that the hospital provides for your use in the hospital Lab and testing services billed by the hospital and done with other hospital services Hospital stays that are only for testing, unless the tests cannot be done without inpatient hospital facilities, or your condition makes inpatient care medically necessary Any days of inpatient care beyond what is medically necessary to treat the condition This plan covers mental health care and treatment for alcohol and drug dependence. This plan will also cover alcohol and drug services from a state-approved treatment program. You must also get these services in the lowest cost type of setting that can give you the care you need. When medically appropriate, services may be provided in your home. This plan will comply with federal mental health parity requirements. Some services require prior authorization. See Prior Authorization for details.
Hospital Services. Hospital staff nurses, scrub nurses, standard private or semi-private room and board and other medically necessary treatments or services ordered by a physician for the Insured who is admitted to a hospital. Private nurse and standard private room upgrade to junior suite or suite are not included in Hospital Services.
Hospital Services. Medically necessary treatments or services ordered by a physician for the Insured who is admitted to a hospital.
Hospital Services. Inpatient and outpatient rates will be based upon the final contracted rate.
Hospital Services. 1. Ancillary Services Benefits are payable for all ancillary services usually provided and billed for by Hospitals (except for personal convenience items) including, but not limited to, the following: Drugs and medicines provided for use while an inpatient; Use of operating or treatment rooms and equipment; Oxygen and administration of oxygen; Administration of whole blood, blood plasma and blood components when medically necessary to include the processing and preparation; and Medical and surgical dressings, casts and splints.
2. Room and Board Benefits are payable for general nursing care and such other services as are covered by the Hospital's regular charges for accommodations in the following: A semi-private room (two or more beds); A bed in a special accommodations unit; or A private room, if Medically Necessary or if no semi-private accommodations are available. A private room is not Medically Necessary when used solely for the comfort and/or convenience of the Member. When a private room is selected at the Member’s option, the Member is responsible for paying ten percent (10%) of the hospital’s private room charge.
Hospital Services. Coverage is only provided when in-patient hospitalization is medically necessary.
(a) Standard private or semi-private hospital room and board is covered within the Bupa Essential Provider Network up to one hundred percent (100%) of the usual, reasonable and customary hospital charges.
(b) Room and board within an intensive care unit is covered within the Bupa Essential Provider Network up to one hundred percent (100%) of the usual, reasonable and customary hospital charges.
(c) Hospital services outside the Bupa Essential Provider Network are not covered, except as provided under policy condition 6.4.
Hospital Services. Enrollees shall have a choice of two (2) hospitals within the applicable time and distance standards set forth in Section 2.8.
2.1.1 except that if only one (1) hospital is located within a County, the second hospital may be within a fifty (50) mile radius of the Enrollee’s ZIP code of residence; Nursing Facilities
2.1.1. except that if only one (1) nursing facility is located within a County, the second nursing facility may be within a fifty (50) mile radius of the Enrollee’s ZIP code of residence. In addition, the Contractor must demonstrate annually that its Provider Network has sufficient providers to ensure that each Enrollee has a choice of at least two (2) outpatient and diversionary Behavioral Health Providers and two (2) community LTSS providers per Covered Service as referenced in Appendix A and defined in Appendix B that are either within a fifteen (15)mile radius or thirty (30) minutes from the Enrollee’s ZIP code of residence, except that with EOHHS prior approval, Contractor may offer Enrollee only one community LTSS provider per Covered Service.
