IN PATIENT CARE Sample Clauses

IN PATIENT CARE. In Patient Care means treatment for which the insured person has to stay in a hospital for more than a day for a covered event.
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IN PATIENT CARE. In-Patient care will be covered only once the member from Emergency care is requested and medically necessary for confinement. 1 Room and Board Accommodation Subject to the Member’s Room and Board limit 2 All other items directly related in the medical management of the patient, as deemed medically necessary by the Attending Affiliated Physician Subject to ABL 3 Room upgrade in case of room unavailability Covered until room availability
Sample 1
IN PATIENT CARE. PHE shall not, nor shall it permit PHE --------------------------------- Providers to discriminate against any Covered Person on the basis of race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, handicap, Plan membership or source of payment including but not limited to Medicaid or Medicare or frequency or cost of utilization of Covered Services. PHE shall, and shall cause Medical Group, Physicians and Health Care Providers to, render health care services to patients who are Covered Persons in all lines of business in the same manner, in accordance with the same standards, and subject to the same access to appointments and services as are offered to its patients and which in any case shall meet the requirements of Section 2.2 hereof.
Sample 1
IN PATIENT CARE. Provides compensation of the cost of surgical and conservative In-Patient Care (instrumental and laboratory examinations for diagnostics, therapeutic and surgical treatment, medicines, parenteral and enteral nutrition, standard and intensive care xxxx) occurred during the insurance period in the presence of medical evidence and appointed by the doctor.
Sample 1
IN PATIENT CARE. Coverage of in-patient benefits, shall be subject to the following conditions: i. The hospital confinement must be recommended by an Affiliated Physician from Emergency care, and approved by the duly Authorized Representative of Maxicare in that Affiliated Hospital prior to confinement. ii. The confinement shall be in an Affiliated Hospital and in accordance with the Member’s Room and Board Accommodation. iii. Professional services shall be provided only by Affiliated Physicians and/or Maxicare Coordinator. iv. If a Member for whom discharge order has been issued by the Attending Physician refuses to be discharged, Maxicare shall no longer be responsible for all hospital expenses and Professional Fees incurred after the specific time or hour the Member should have been discharged. Such expenses shall be charged to the personal account of the Member. v. Maxicare shall issue the requisite Letter of Authorization (LOA) and other necessary documents prior to the availment of any In-patient Care.
Sample 1

Related to IN PATIENT CARE

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

  • Urgent Care This plan covers services received at an urgent care center. For other services, such as surgery or diagnostic tests, the amount that you pay is based on the type of service being provided. See Summary of Medical Benefits for details. Follow-up care (such as suture removal or wound care) should be obtained from your

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.

  • Specialty Prescription Drugs (+ Prorated copayments for a shorter supply period may apply for network pharmacy only. See Prescription Drug section for details. When purchased at a Specialty Pharmacy (+): For maintenance and non-maintenance prescription drugs, a copayment applies for each 30-day period (or portion thereof) within the prescribed dosing period. Tier 5: $125 Not Covered When purchased at a Retail Pharmacy (+): For maintenance and non-maintenance prescription drugs, a copayment applies for each 30-day period (or portion thereof) within the prescribed dosing period. Specialty Prescription Drugs purchased at a retail pharmacy will require a significantly higher out of pocket expense than if purchased from a Specialty Pharmacy. Our reimbursement is based on the pharmacy allowance. Tier 5: 50% Not Covered When purchased at a Mail Order Pharmacy: Not Covered Not Covered (+) Preauthorization is required for this service. Please see Preauthorization in Section 3 for more information. You Pay You Pay Infertility Prescription Drugs - Three (3) in-vitro cycles will be covered per plan year with a total of eight (8) in-vitro cycles covered in a member’s lifetime. When purchased at a Specialty, Mail Order, or Retail Pharmacy Tier 1: 20% Not Covered Tier 2: 20% Not Covered Tier 3: 20% Not Covered Tier 4: 20% Not Covered When purchased at a Specialty Pharmacy (+) Tier 5: 20% Not Covered When purchased at a Retail Pharmacy (+): Specialty Prescription Drugs purchased at a retail pharmacy will require a significantly higher out of pocket expense than if purchased from a specialty pharmacy. Tier 5: 20% Not Covered Contraceptive Methods - Preventive Coverage includes barrier method (diaphragm or cervical cap), hormonal method (birth control pill), and emergency contraception. For non-preventive contraceptive prescription drugs and devices, the amount you pay will depend on the tier placement of the contraceptive prescription drug or device. See above for details. When purchased at a Retail Pharmacy: Up to a 365-day supply of contraceptive prescription drugs is available at all network retail pharmacies. For more information about this option, visit our website. Tier 1: $0 Not Covered When purchased at a Mail Order Pharmacy: Up to a 90-day supply. Tier 1: $0 Not Covered

  • Hospice Care If you have a terminal illness and you agree with your physician not to continue with a curative treatment program, this plan covers hospice care services received in your home, in a skilled nursing facility, or in an inpatient facility.

  • Medical Care The Parents must comply with the School Medical Officer's recommendations which may include a reasonable decision to release the Pupil home or to her education guardian when she is unwell.

  • 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.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • 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

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.