HOSPITAL SERVICES EXCLUDE THE FOLLOWING Sample Clauses

HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraph 4 above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs, including immunosuppressive drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility.
Sample 1
AutoNDA by SimpleDocs
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 10(a) above. b. Medical Services in the IPA Service Area as defined by Attachment B hereto. c. Outpatient prescription drugs, including immunosuppressive drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility. e. Vision materials (lenses and frames) except for those surgically implanted during cataract surgery. f. Anesthesiology services (inpatient and outpatient). g. Experimental procedures, including any type of procedure not generally recognized as of value by the medical community and its societies, as determined by PacifiCare and IPA, in conformance with state and federal law. h. Cosmetic Surgery, except when performed to correct or repair the physical functioning of a body part as a result of a functional disorder or accidental injury. i. Inpatient hospital care in excess of one hundred fifty (150) days per Subscriber per Year except as provided in Paragraph 1 of this Attachment A. j. Skilled nursing care in excess of one hundred (100) days per Subscriber per Year. k. Respite Care
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 10(a) above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs.
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING. (a) Durable Medical Equipment (except as provided in Section 8 above); (b) Medical Services in the Service Area as defined by Exhibit L; (c) Outpatient prescription drugs (d) Vision materials (lenses and frames or contact lenses), except lenses surgically implanted during cataract surgery during outpatient surgery at a Hospital outpatient department or an ambulatory surgical center.
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 10(a) above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs, including immunosuppressive drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility. e. Vision materials (lenses and frames) except for those surgically implanted during cataract surgery. f. Anesthesiology services (inpatient and outpatient). g. Experimental procedures, including any type of procedure not generally recognized as of value by the medical community and its societies, as determined by PacifiCare and IPA, in conformance with state and federal law. h. Cosmetic Surgery, except when performed to correct or repair the physical functioning of a body part as a result of a functional disorder or accidental injury. i. Inpatient hospital care in excess of one hundred fifty (150) days per Subscriber per Year, except as provided in Paragraph 1 of this Attachment A1. j. Skilled nursing care in excess of one hundred (100) days per Subscriber per Year, except as provided in Paragraph 2 of this Attachment A1. k. Respite Care EXHIBIT 2 ATTACHMENT B MEDICAL SERVICES I. Medical Services, other than Hospital Services, provided in the IPA Service Area are the financial responsibility of IPA. A summary of most Medical Services includes the following: 1. PHYSICIAN SERVICES - Subscribers shall be entitled to Medically Necessary covered inpatient and outpatient physician services included in the PacifiCare's Secure Horizons Medical and Hospital Plan. A summary of some physician services includes the following: a. IPA Service Area inpatient services (including anesthesiology services and physician services associated with non- experimental transplants, as defined by Medicare) and outpatient physician care. b. Professional component of inpatient mental health. c. Outside referrals to consultants including Emergency Room consultants (not including emergency room charges). d. Out-of-IPA Service Area physician services when such Medical Services are rendered on an elective basis and upon approval of IPA. 2. OUTPATIENT SERVICES - Such services include, among others: a. Outpatient pathology and radiology. b. Outpatient mental heal...
Sample 1

Related to HOSPITAL SERVICES EXCLUDE THE FOLLOWING

  • Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Compliance Control Services (1) Support reporting to regulatory bodies and support financial statement preparation by making the Fund's accounting records available to the Trust, the Securities and Exchange Commission (the “SEC”), and the independent accountants. (2) Maintain accounting records according to the 1940 Act and regulations provided thereunder. (3) Perform its duties hereunder in compliance with all applicable laws and regulations and provide any sub-certifications reasonably requested by the Trust in connection with any certification required of the Trust pursuant to the Xxxxxxxx-Xxxxx Act of 2002 (the “SOX Act”) or any rules or regulations promulgated by the SEC thereunder, provided the same shall not be deemed to change USBFS’s standard of care as set forth herein. (4) Cooperate with the Trust’s independent accountants and take all reasonable action in the performance of its obligations under this Agreement to ensure that the necessary information is made available to such accountants for the expression of their opinion on the Fund’s financial statements without any qualification as to the scope of their examination.

  • Dental Services The following dental services are not covered, except as described under Dental Services in Section 3: • Dental injuries incurred as a result of biting or chewing. • General dental services including, but not limited to, extractions including full mouth extractions, prostheses, braces, operative restorations, fillings, frenectomies, medical or surgical treatment of dental caries, gingivitis, gingivectomy, impactions, periodontal surgery, non-surgical treatment of temporomandibular joint dysfunctions, including appliances or restorations necessary to increase vertical dimensions or to restore the occlusion. • Panorex x-rays or dental x-rays. • Orthodontic services, even if related to a covered surgery. • Dental appliances or devices. • Preparation of the mouth for dentures and dental or oral surgeries such as, but not limited to, the following: o apicoectomy, per tooth, first root; o alveolectomy including curettage of osteitis or sequestrectomy; o alveoloplasty, each quadrant; o complete surgical removal of inaccessible impacted mandibular tooth mesial surface; o excision of feberous tuberosities; o excision of hyperplastic alveolar mucosa, each quadrant; o operculectomy excision periocoronal tissues; o removal of partially bony impacted tooth; o removal of completely bony impacted tooth, with or without unusual surgical complications; o surgical removal of partial bony impaction; o surgical removal of impacted maxillary tooth; o surgical removal of residual tooth roots; and o vestibuloplasty with skin/mucosal graft and lowering the floor of the mouth. • The following dialysis services received in your home: o installing or modifying of electric power, water and sanitary disposal or charges for these services; o moving expenses for relocating the machine; o installation expenses not necessary to operate the machine; and o training in the operation of the dialysis machine when the training in the operation of the dialysis machine is billed as a separate service. • Dialysis services received in a physician’s office.

  • 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.

  • Diagnostic Services All necessary procedures to assist the dentist in evaluating the existing conditions to determine the required dental treatment, including: Oral examinations Consultations

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18 and 19, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State. 2. Notwithstanding the provisions of paragraph 1, remuneration derived by a resident of a Contracting State in respect of an employment exercised in the other Contracting State shall be taxable only in the first-mentioned State if: a) the recipient is present in the other State for a period or periods not exceeding in the aggregate 183 days in any twelve-month period commencing or ending in the tax year concerned, and b) the remuneration is paid by, or on behalf of, an employer who is not a resident of the other State, and c) the remuneration is not borne by a permanent establishment or a fixed base which the employer has in the other State. 3. Notwithstanding the preceding provisions of this Article, remuneration derived in respect of an employment exercised aboard a ship or aircraft operated in international traffic by a resident of a Contracting State, may be taxed in that State.

  • Elements Unsatisfactory Needs Improvement Proficient Exemplary IV-A-1. Reflective Practice Demonstrates limited reflection on practice and/or use of insights gained to improve practice. May reflect on the effectiveness of lessons/ units and interactions with students but not with colleagues and/or rarely uses insights to improve practice. Regularly reflects on the effectiveness of lessons, units, and interactions with students, both individually and with colleagues, and uses insights gained to improve practice and student learning. Regularly reflects on the effectiveness of lessons, units, and interactions with students, both individually and with colleagues; and uses and shares with colleagues, insights gained to improve practice and student learning. Is able to model this element.

  • Substance Abuse Program The SFMTA General Manager or designee will manage all aspects of the FTA-mandated Substance Abuse Program. He/she shall have appointing and removal authority over all personnel working for the Substance Abuse Program personnel, and shall be responsible for the supervision of the SAP.

  • Use; Quality Control a. Neither party may alter the other party’s trademarks from the form provided and must comply with removal requests as to specific uses of its trademarks or logos. b. Each party agrees to use, and to cause its Permitted Sublicensees to use, the other party’s trademarks only in good faith and in a dignified manner consistent with such party’s use of the trademarks. Upon written notice to the breaching party, the breaching party has 30 days of the date of the written notice to cure the breach or the license will be terminated.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!