OUT-PATIENT SERVICES Sample Clauses

OUT-PATIENT SERVICES. Medical treatments or services provided or ordered by a physician for the insured when he/she is not admitted in a hospital. Out-patient services include services performed in a hospital or emergency room if these services have a duration of less than twenty-four (24) hours. PANDEMIC: An epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population. PHYSICIAN OR DOCTOR: A professional legally licensed to practice medicine in the country where treatment is provided while acting within the scope of his/her practice. The term “physician” or “doctor” shall also apply to a professional legally licensed to practice as a dentist. POLICY DUE DATE: The date on which the premium is due and payable. POLICY EFFECTIVE DATE: The date stated in the certificate of coverage, on which coverage under this policy begins. POLICY YEAR: The period of twelve (12) consecutive months beginning on the effective date of the policy and any subsequent twelve-month period thereafter.

OUT-PATIENT SERVICES. Medical treatments or services provided or ordered by a physician for the insured when he/she is not admitted in a hospital. Out-patient services include services performed in a hospital or emergency room if these services have a duration of less than twenty-four (24) hours. PHYSICIAN OR DOCTOR: A professional legally licensed to practice medicine in the country where treatment is provided while acting within the scope of his/her practice. The term “physician” or “doctor” shall also apply to a professional legally licensed to practice as a dentist. PANDEMIC: An epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population. POLICY DUE DATE: The date on which the premium is due and payable. POLICY EFFECTIVE DATE: The date stated in the certificate of coverage, on which coverage under this policy begins. POLICY YEAR: The period of twelve (12) consecutive months beginning on the effective date of the policy and any subsequent twelve-month period thereafter.

OUT-PATIENT SERVICES. Coverage is only provided when medically necessary. 6 | TERMS AND CONDITIONS

OUT-PATIENT SERVICES. The Insurer will pay reasonable and customary costs when by reason of sickness or injury, an insured person incurs expenses for any of the following while under the regular care and attendance of a physician: 1. physician’s service fees; 2. one health examination, not to exceed $250 per policy year;

OUT-PATIENT SERVICES. Benefits include family doctor consultations, prescribed drugs, pathology*, imaging*, optical* (refraction, lenses, frames), reproductive health, auto-immune health, dental health*, orthodontics*, nursing at home*, therapy* (physiotherapy, occupational therapy, speech therapy, chiropractor), appliances and equipment, specialist consultations*, hearing tests and treatment. Each benefit listed is the full benefit up to renewal for each member. Benefit use is driven by the AHFoZ codes used by the treating practitioner/service provider. The AHFoZ codes specify the discipline of the provider and the treatment provided, regardless of the nature of the complaint (chronic/acute) or the location of the patient (in hospital/out of hospital). Claims are then allocated accordingly to benefits. Please refer also to the table of benefits for benefit limits and waiting periods Claims can only be made against the benefits listed, for the diagnosis, treatment and management of conditions recognised as debilitating diseases, disorders or conditions that left untreated would result in the inevitable consequence of death or permanent serious debilitation to the member. Claims for outpatient services are a on a pay and claim basis only unless a specific service provider direct billing agreement has been concluded between Alliance Health and the Service Provider. All costs relating to inpatient treatment, advanced imaging, diagnostic testing and specialist consultations must be pre-authorised by Alliance Health. Settlement of costs and provision of benefits are subject to the tariffs, limits and waiting periods specified on the Table of Benefits for Alliance Options Select. Claims for level one and level two scheme claims are paid at AHFoZ tariffs up to the annual limits specified. Claims for level three and level four scheme claims are paid up to 200% of AHFoZ tariffs and up to the annual limits specified. All costs that are over and above AHFoZ tariffs will be settled by the MEMBER. Claims can only be paid for the appropriate services related to the discipline under which the Medical Service Provider has registration for with the appropriate authorised regulatory body in the country of treatment. On receipt of a claim made against benefits for any member Alliance Health has full authority to obtain all information relating to the claim, the event and the circumstances surrounding the event from relevant medical personnel subject to privacy laws of the Republic of Zimbabwe. If...

OUT-PATIENT SERVICES. Medical treatments or services provided or ordered by a physician for the insured when he/she is not admitted in a hospital. Out-patient services include services performed in a hospital or emergency room if these services have a duration of less than twenty-four (24) hours. PHYSICIAN OR DOCTOR: A professional legally licensed to practice medicine in the country where treatment is provided while acting within the scope of his/her practice. The term “physician” or “doctor” shall also apply to a professional legally licensed to practice as a dentist.