Hospital-Surgical (Effective Sample Clauses

Hospital-Surgical (Effective. 1/1/06). For the duration of this Agreement, the County shall provide a comprehensive hospital-surgical-major medical coverage policy and a $25 deductible dental plan. The County will continue to provide a Dental Maintenance Organization (currently Dental Associates) with a $2,200 annual cap, a $20 co-pay and a 50% split on orthodontia. Effective January 1, 2007, the Dental Associates annual cap will increase to $2,500 per eligible participant. Active employees will have the option of choosing one of two Network options, In-Network or Out-of-Network. Said option must be executed during the open enrollment period which will last for one month, from October 1 through October 31 of the current year. A. All physician visits and all diagnostic lab, x-ray, CT scan, MRI, etc., subject to the following co-pay with a cap of 40 visits for single/ 60 visits for a family of two/ and 80 visits for a family of three or more: 2005 - $25.00 2006 - $27.00 2007 - $29.00 2008 - $30.00 B. All in-patient and out-patient and ER visits subject to the following: In-Xxx. $100 Out-Xxx. $100 ER $100 Any admission or referral to a physician to schedule either In- or Out-Patient surgery within five days of an ER visit will not be subject to the In- or Out-Patient $100 deductible. Rx – Co-Pays Generic - $10.00* Formulary Brand - $22.00** Non-formulary Brand - $44.00** * includes 90 day supply ** two co-pays for 90 day supply DENTAL • Annual cap = $2,200 (increasing to $2,500 on 1/1/07) • No deductible • Co-pay = $20/visit • Orthodontia coverage = 50% split • Routine cleaning & xrays = free twice a year A. All claims subject to a $600 deductible to a maximum of three (3) per family. B. After the deductible is satisfied, co-insurance of 75%/25% on the next $7,000 ($1,750) single and $13,000 ($3,250) family. C. All in-patient and out-patient and ER visits subject to the deductible and the 75%/25% split in “B” above. Rx – Co-Pays Generic - $10.00* Formulary Brand - $22.00** Non-formulary Brand - $44.00** * includes 90 day supply ** two co-pays for 90 day supply DENTAL • Annual cap = $1,250 • $25 deductible per person • Preventive & basic services = 80%/20% split on usual & customary charges • Major & prosthodontic services = 50% split • Orthodontia coverage = $1,000 lifetime (a) For employees enrolled for coverage for the employee only--- the full premium cost of the coverage. (b) For employees enrolled for coverage for the employee and his/her dependents---the full premium cost of the cov...
Sample 1
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Hospital-Surgical (Effective. 1/1/05). For the duration of this Agreement, the County shall provide a comprehensive hospital-surgical-major medical coverage policy and a $25 deductible dental plan. The County will continue to provide a Dental Maintenance Organization (currently Dental Associates) with a $10 copay and a 50/50 split on orthodontia. The Dental Associates plan will have an annual maximum benefit on all covered dental work, other than orthodontia, of $2,000 for the years 2003 and 2004. The maximum benefit will increase to $2,200 for the years 2005 and thereafter. Active employees will have the option of choosing one of two Network options, In-Network or Out- of-Network. Said option must be executed during the open enrollment period which will last for one month, from October 1 through October 31 of the current year. A. All physician visits and all diagnostic lab, x-ray, CT scan, MRI, etc., subject to a $25 co-pay with a cap of 40 visits for single/ 60 visits for a family of two/ and 80 visits for a family of three or more. B. All in-patient and out-patient and ER visits subject to the following: Year 1 Year 2 In-Xxx. $ 75 $ 75 Out-Xxx. $ 75 $100 ER $100 $100 Any admission or referral to a physician to schedule either In- or Out-Patient surgery within five days of an ER visit will not be subject to the In- or Out-Patient $75 or $100 deductible. Rx – Co-Pays Generic - $8.00 Formulary Brand - $20.00 Non-formulary Brand - $40.00 A. All claims subject to a $600 deductible to a maximum of three (3) per family. B. After the deductible is satisfied, co- insurance of 75%/25% on the next $7,000 ($1,750) single and $13,000 ($3,250) family. C. All in-patient and out-patient and ER visits subject to a $200 deductible prior to the 75%/25% split in “B” above. Rx – Co-Pays Generic - $8.00 Formulary Brand - $20.00 Non-formulary Brand - $40.00 (a) For employees enrolled for coverage for the employee only--- the full premium cost of the coverage. (b) For employees enrolled for coverage for the employee and his/her dependents---the full premium cost of the coverage. (c) During the life of this Agreement, the County agrees to maintain hospital-surgical-major medical and dental coverage at levels equivalent to coverages presently in effect, and to improve such coverage where possible. (d) An employee who becomes totally disabled due to work con- nected injury or illness shall continue to receive coverage paid by the County during such period of total disability until such employee becomes eligib...
Sample 1

Related to Hospital-Surgical (Effective

  • 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 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.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. 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.

  • 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.

  • 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.

  • 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

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

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