MEDICAL SERVICE BENEFITS Sample Clauses

MEDICAL SERVICE BENEFITS. ‌ The plan provides coverage for health care services for a member or covered dependent member. Some services require prior authorization. Copayment, deductibles, and coinsurance amounts must be paid to your network provider at the time you receive services. All covered services are subject to conditions, exclusions, limitations, terms and provisions of this contract. Covered services must be medically necessary and not experimental or investigational. Essential health benefits are defined by federal and state law and refer to benefits in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care. Essential health benefits provided within this policy are not subject to lifetime or annual dollar maximums. Certain non-essential health benefits, however, are subject to either a lifetime or annual dollar maximum. Benefit Limitations Limitations may also apply to some covered services that fall under more than one covered service category. Please review all limits carefully. Ambetter of Illinois insured by Celtic Insurance Company will not pay benefits for any of the services, treatments, items or supplies that exceed benefit limits. Ambulance Service Benefits (Ground) Covered service will include ambulance services for ground and water transportation from home, scene of accident, or medical emergency: