Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. An individual duly licensed to provide primary nursing and basic medical services. Care received from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Such amount does not include Premiums or charges for Non- Covered Services or fees in excess of the MAC. When the Out-of- Pocket Maximum is reached, the plan pays 100 %of the MAC for Covered Services.
Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. An individual duly licensed to provide primary nursing and basic medical services. Care received from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.
Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia, or accredited by the Joint Commission on Accreditation of Hospitals. The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage. A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Services that are not benefits specifically provided under the Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. An individual duly licensed by the State of Georgia to provide primary nursing and basic medical services. Care received by a Member from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have a Network Provider Contract with Alliant. (May apply to In-Network or Out-of-Network—Refer to Summary of Benefits and Coverage’s) The maximum amount of a Member’s Co-payment and Coinsurance payments during a given calendar year. Such amount does not include Deductible amounts, charges for non-covered services or fees in excess of the Maximum Allowed Cost (MAC). When the Out-of-Pocket Limit is reached, the level of benefits is increased to 100% of the Maximum Allowed Cost (MAC) for Covered Services. A medical examination that provides for age-specific preventive services that improve the health and well-being of a patient being examined. This examination is provided through the network by
Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. An individual duly licensed to provide primary nursing and basic medical services. Care received from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In-Network Provider contract with Alliant. The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.
Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness.The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals.
Mental Health Care Provider. An institution such as a Hospital or ambulatory care facilityestablished for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Nurse Practitioner (NP) Out-of-Network Care Out-of-Network Provider Out-of-Pocket Maximum Outpatient A Member who receives medical treatment without beingadmitted to a hospital. A document setting forth certain rules relating to the coverage of pharmaceuticals by Us that may include but notbe limited to (1) a listing of preferred and non- preferred prescription medications that are covered and/or prioritized in order of preference by Us and are dispensed to Members through pharmacies that are Network Providers, and (2) Prior Authorization rules. Physical Therapy Physician
