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Inpatient Services Sample Clauses

Inpatient ServicesHospital services which are not performed in a hospital. • Medical services of the donor that are not directly related to the organ transplant. ▪ Services related to obtaining, storing, or other services performed for the potential future use of umbilical cord blood. • Non-cadaveric small bowel transplants. • Services related to donor searches. • Xxxxx related medical and surgical expenses when the recipient is not covered as a • Services or supplies related to an excluded transplant procedure. • Preimplantation genetic diagnosis, also known as embryo screening. • Amniocentesis or any other service when performed solely to determine gender. • Services related to surrogate parenting or the newborn child of the surrogate parent, when the surrogate is not a member of this plan.
Inpatient ServicesHospital services which are not performed in a hospital. • Medical services of the donor that are not directly related to the organ transplant. ▪ Services related to obtaining, storing, or other services performed for the potential future use of umbilical cord blood. • Non-cadaveric small bowel transplants. • Services related to donor searches. • Xxxxx related medical and surgical expenses when the recipient is not covered as a • Services or supplies related to an excluded transplant procedure.
Inpatient ServicesGeneral hospital or specialty hospital services* Unlimited days 0% - After Deductible 20% - After Deductible Rehabilitation facility services* Limited to 45 days per plan year. 0% - After Deductible 20% - After Deductible Physician hospital visits 0% - After Deductible 20% - After Deductible
Inpatient Services. Inpatient services are covered when such services are prescribed by a physician and when the services are medically necessary for the diagnosis or treatment of the member's condition.
Inpatient ServicesGeneral hospital or specialty hospital services* - Unlimited Days 0% - After deductible 20% - After deductible Rehabilitation facility services* - Limited to 45 days per plan year. 0% - After deductible 20% - After deductible Physician hospital visits 0% - After deductible 20% - After deductible Inpatient - see Mastectomy Services in Section 3 for details. 0% 20% - After deductible Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% 20% - After deductible Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% 20% - After deductible
Inpatient ServicesGeneral hospital or specialty hospital services* - Unlimited Days 10% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 10% - After deductible Not Covered Physician hospital visits 10% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not Covered
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Inpatient Services.  Hospital services which are not performed in a hospital.  Medical services of the donor that are not directly related to the organ transplant.  Services related to obtaining, storing, or other services performed for the potential future use of umbilical cord blood.  Noncadaveric small bowel transplants.  Services related to donor searches.  Donor related medical and surgical expenses when the recipient is not covered as a  Services or supplies related to an excluded transplant procedure.  Preimplantation genetic diagnosis, also known as embryo screening.  Amniocentesis or any other service when performed solely to determine gender.  Biological products for allergen immunotherapy and vaccinations.  Blood fractions.  Compound prescription drugs that are not made up of at least one legend drug.  Bulk powders and chemicals used in compound prescriptions that are not FDA approved, are not covered unless listed on our formulary.  Prescription drugs prescribed or dispensed outside of our dispensing guidelines.  Prescription drugs that have not proven effective according to the FDA.  Prescription drugs used for cosmetic purposes.  Prescription drugs purchased from a non-designated pharmacy, if a pharmacy has been designated for you through the Pharmacy Home Assignment program.  Experimental prescription drugs including those placed on notice of opportunity hearing status by the Federal Drug Efficacy Study Implementation (DESI).  Prescription drugs provided to you that are not dispensed by a network pharmacy or covered under your medical plan.  Prescription drugs and diabetic equipment and supplies purchased at a non-network pharmacy unless indicated as covered in the Summary of Pharmacy Benefits.  Prescription drug related medical supplies except for diabetic, regardless of the reason prescribed, the intended use, or medical necessity. Examples include, but are not limited to, alcohol pads, bandages, wraps or pill holders.  Off-label use of prescription drugs except as described in Experimental or Investigational Services in Section 3;  Prescribed weight-loss drugs.  Replacement of prescription drugs resulting from a lost, stolen, broken or destroyed prescription order or refill.  Therapeutic devices and appliances, including hypodermic needles and syringes except when used to administer insulin.  Prescription drugs, therapeutic equivalents, or any other pharmaceuticals used to treat sexual dysfunctions.  Vitamins, unless specifically l...
Inpatient ServicesGeneral hospital or specialty hospital services* - Unlimited Days Standard $1,500 - After deductible Not Covered Enhanced $750 Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. Standard $1,500 - After deductible Not Covered Enhanced $750 Not Covered Physician hospital visits 0% Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not Covered In a hospital or other health care facility Standard 0% - After deductible Not Covered Enhanced 0% Not Covered Office Visits - (Other than Preventive Care Services. See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies to injection only, including administration. $0 Not Covered Hospital based clinic visits $40 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. Standard $30 Not Covered Enhanced $15 Not Covered Retail clinics $30 Not Covered Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. $40 Not Covered Office visits and house calls rendered by a behavioral health specialist. $15 Not Covered Podiatrist Services - one foot evaluation in a plan year when performed to treat members with a systemic condition such as metabolic, neurologic, or peripheral vascular disease. $0 Not Covered Organ transplant services 0% - After deductible Not Covered Outpatient hospital/in a physician’s/therapist’s office. $40 Not Covered Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay
Inpatient ServicesGeneral hospital or specialty hospital services* - Unlimited Days 0% - After deductible 40% - After deductible Rehabilitation facility services* - Limited to 45 days per plan year. 0% - After deductible 40% - After deductible Physician hospital visits 0% - After deductible 40% - After deductible Inpatient - see Mastectomy Services in Section 3 for details. 0% - After deductible 40% - After deductible Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% - After deductible 40% - After deductible Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% - After deductible 40% - After deductible In a hospital or other health care facility 0% - After deductible 40% - After deductible
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