Inpatient Services Sample Clauses

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. • Non-cadaveric small bowel transplants. • Services related to donor searches. • ▇▇▇▇▇ 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 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. • Non-cadaveric small bowel transplants. • Services related to donor searches. • ▇▇▇▇▇ related medical and surgical expenses when the recipient is not covered as a • Services or supplies related to an excluded transplant procedure.

Inpatient Services. General 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 Services. General hospital or specialty hospital services* - Unlimited Days 0% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 0% - After deductible Not Covered Physician hospital visits 0% - 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 In a hospital or other health care facility 0% - After deductible 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 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% - After deductible Not Covered Hospital based clinic visits $30 Not Covered Pediatric clinic visit PCP practices with PCMH model of care $10 Not Covered PCP does not practice with PCMH model of care $20 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls. PCP practices with PCMH model of care First non-preventive visits rendered by a PCP in the plan year $0 Not Covered Subsequent non-preventive visits rendered by a PCP in the plan year $10 Not Covered PCP does not practice with PCMH model of care First non-preventive visits rendered by a PCP in the plan year $0 Not Covered Subsequent non-preventive visits rendered by a PCP in the plan year $20 Not Covered Retail clinics $20 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. $30 Not Covered Office visits and house calls rendered by a behavioral health specialist. $20 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/ther...

Inpatient Services. General 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. General 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

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 Services. General 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

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 0% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 0% - After deductible Not Covered Physician hospital visits 0% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% - After deductible Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% - After deductible Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% - After deductible Not Covered