Other Emergency Care Sample Clauses

Other Emergency Care. Charges made by a Doctor of Medicine (M.D.) or a Doctor of Osteopathy (D.O.) for emergency care rendered in a medical facility or a Physician's office following an accident. BENEFIT PAYMENT FOR EMERGENCY ROOM/URGENT CARE VISITS: IN-NETWORK COVERAGE ONE HUNDRED PERCENT (100%) OF ELIGIBLE EXPENSES AFTER A $200 COPAYMENT FOR EMERGENCY CARE VISITS, AND $50 COPAYMENT FOR URGENT CARE VISITS OUT-OF-NETWORK COVERAGE ONE HUNDRED PERCENT (100%) OF ELIGIBLE EXPENSES AFTER A $200 COPAYMENT FOR EMERGENCY CARE VISITS, AND $50 COPAYMENT FOR URGENT CARE VISITS ALL OTHER OUTPATIENT SERVICES WILL BE COVERED AS FOLLOWS:  IN-NETWORK COVERAGE IN-NETWORK COINSURANCE FOR ELIGIBLE EXPENSES AFTER THE DEDUCTIBLE UP TO IN-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL  OUT-OF-NETWORK COVERAGE OUT-OF-NETWORK COINSURANCE OF ELIGIBLE EXPENSES AFTER THE OUT-OF-NETWORK DEDUCTIBLE UP TO OUT-OF-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL
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Related to Other Emergency Care

  • Emergency Care If you need emergency care, call 911 or go to the nearest hospital emergency room. If you are traveling outside our service area and need urgent care, call the Customer Service number provided in the chart above or visit our website and use the “Find A Doctor” feature to find a BlueCard provider.

  • Emergency Calls IP Phones need an additional power supply to operate. In the event of a power failure it is your responsibility to ensure you have the means to make emergency calls. In accordance with paragraph 13.2, we will not be liable for any loss or damage (financial or otherwise) where you fail to do so.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following:

  • Emergency Childcare Employees may use vacation leave for childcare emergencies after the employee has exhausted all of their accrued compensatory time. Use of vacation leave and sick leave for emergency childcare is limited to a combined maximum of four (4) days per calendar year.

  • Emergency Care Services If you experience a medical emergency while traveling outside our service area, go to the nearest emergency or urgent care facility. When you receive Out-of-Area covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for the Out-of-Area Covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: • the billed charges for your Out-of-Area covered healthcare services; or • the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.

  • Medical Emergency A medical condition which manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate attention to result in 1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; 2) serious impairment to bodily functions; or 3) serious dysfunction of any bodily organ or part. Examples of a medical emergency are severe pain, suspected heart attacks and fractures. Examples of a non- medical emergency are minor cuts and scrapes. Medically Necessary and Medical Necessity Services a physician, exercising prudent clinical judgment, would use with a patient to prevent, evaluate, diagnose or treat an illness or injury or its symptoms. These services must:  Agree with generally accepted standards of medical practice  Be clinically appropriate in type, frequency, extent, site and duration., They must also be considered effective for the patient’s illness, injury or disease  Not be mostly for the convenience of the patient, physician, or other healthcare provider. They do not cost more than another service or series of services that are at least as likely to produce equivalent therapeutic or diagnostic results for the diagnosis or treatment of that patient’s illness, injury or disease. For these purposes, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer reviewed medical literature. This published evidence is recognized by the relevant medical community, physician specialty society recommendations and the views of physicians practicing in relevant clinical areas and any other relevant factors. Member Any person covered under this plan. Mental Condition A condition that is listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This does not include conditions and treatments for chemical dependency. Mental Health Services Medically necessary outpatient and inpatient services provided to treat mental conditions. State and federal law require that the copays and coinsurance for mental health services will be no more than the copays and coinsurance for medical and surgical services. Prescription drugs for mental conditions are covered under the same terms and conditions as other prescription drugs covered under this plan.

  • Child or Elder Care Emergencies Leave without pay, compensatory time or paid leave may be granted for child or elder care emergencies.

  • Medical Emergencies If you encounter a medical emergency that makes you unable to pay your bill for a period of time, or that requires your account remain active, even if it has already been suspended or disconnected, Viasat may payment or reconnection options available for you. You must contact Viasat immediately upon learning of such emergency to determine what options are available in your situation. If you reside in Maine or Pennsylvania, please contact us regarding the specific procedures to follow for relief.

  • Emergency Contacts Contractor shall provide County with a list of names and telephone numbers at which Contractor’s representative, alternate, superintendent, and other key personnel can be reached during non-working hours in the case of an emergency.

  • Emergency Contact CONTRACTOR shall have a responsible person available at, or reasonably near, the Project/Service on a twenty-four (24) hour basis, seven (7) days a week, who may be contacted in emergencies and in cases where immediate action must be taken to handle any problem that might arise. CONTRACTOR shall submit to the COUNTY’s Project Manager, the phone numbers and names of personnel designated to be contacted in cases of emergencies. This list shall contain the name of their supervisors responsible for work pertaining to this Agreement.

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