Outpatient Emergency Sample Clauses

Outpatient Emergency. Service - medical service necessary for Policyholder being in urgent situation provided in medical institution during insurance period (costs of clinical, instrumental, laboratory analysis and outpatient manipulations, medication, preparations), which doesn’t need delay more than 24 hours in medical institution.
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Outpatient Emergency. (Hospital and Physician) Emergency Medical and Emergency Accident - Treatment in a hospital or physician's office for accidental injuries or sudden and unexpected medical conditions with severe life-threatening symptoms only. Note: Non-life threatening emergency medical and accident treatment is covered after the deductible at PPO & Non-PPO network coinsurance levels. (The Supplemental Accident $50,000 for inpatient and outpatient services. Inpatient care $50,000 for inpatient and outpatient services. Outpatient care Medical/Surgical Care: Including Durable Medical Equipment, Home Infusion Therapy and Advanced Practice Nurses. Payments based on the Schedule of Maximum Allowances for all PPO Network providers. PPO Providers have agreed to accept the Schedule of Maximum Allowances as payment in full for covered services, excluding your deductible and any coinsurance. Family (Aggregate) 100% 100% 100% 100%** 90% after $75 co-pay, co-pay waived if admitted Family (Aggregate) 80% 80% 75%** 80%** $75 co-pay, co-pay waived if admitted Prescription Drug benefit, 34 day supply paid at 100% after copayment at all participating pharmacies. $25 co-pay formulary; $40 co-pay nonformulary $40 co- pay*** Medical Services Advisory (Inpatient Utilization Review): Notification required prior to all elective admissions, Private Duty Nursing, Skilled Nursing Facilities and Coordinated Home Care, Emergency and Obstetric Admission Notification required within 2 working days of admittance. If employee elects not to notify MSA Advisory or follow advice given, hospital benefits are reduced by $200. ***If a generic is available and a brand name is dispensed, the employee will pay the difference between the brand name and the generic plus the brand name co-pay; the only exception will be when the generic has an adverse effect on the employee’s health as certified by a physician.

Related to Outpatient Emergency

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Inpatient If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section

  • Dependent Care Assistance Program The County offers the option of enrolling in a Dependent Care Assistance Program (DCAP) designed to qualify for tax savings under Section 129 of the Internal Revenue Code, but such savings are not guaranteed. The program allows employees to set aside up to five thousand dollars ($5,000) of annual salary (before taxes) per calendar year to pay for eligible dependent care (child and elder care) expenses. Any unused balance is forfeited and cannot be recovered by the employee.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following: 1. A personal illness, injury or medical emergency. 2. The death, illness, injury or medical emergency of an individual described in this Article. 3. An urgent matter that concerns an individual described in this Article. For the purposes of this Article, the individuals referred to in this Article are: - the employee’s spouse - a parent, step-parent or xxxxxx parent of the employee or the employee’s spouse - a child, step-child or xxxxxx child of the employee or the employee’s spouse - a grandparent, step-grandparent, grandchild or step-grandchild of the employee or of the employee’s spouse - the spouse of a child of the employee - the employee’s brother or sister - a relative of the employee who is dependent on the employee for care or assistance. An employee who wishes to take leave under this section shall advise his or her Hospital that he or she will be doing so. If the employee must begin the leave before advising the Hospital, the employee shall advise the Hospital of the leave as soon as possible after beginning it. An employee is entitled to take a total of 10 days’ leave under this section each year. If an employee takes any part of a day as leave under this section, the Hospital may deem the employee to have taken one day’s leave on that day for the purposes of this Article. The Hospital may require an employee who takes leave under this section to provide evidence reasonable in the circumstances that the employee is entitled to the leave. Upon the conclusion of an employee’s leave under this Article, the Hospital shall reinstate the employee to the position the employee most recently held with the Hospital, if it still exists, or to a comparable position, if it does not.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Contingent Emergency Response 1. In order to ensure the proper implementation of contingent emergency response activities under Part 4 of the Project (“Contingent Emergency Response Part”), the Recipient shall ensure that: (a) a manual (“CERC Manual”) is prepared and adopted in form and substance acceptable to the Association, which shall set forth detailed implementation arrangements for the Contingent Emergency Response Part, including: (i) any structures or institutional arrangements for coordinating and implementing the Contingent Emergency Response Part;

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • Medically Necessary In general, We will not Cover any dental service, procedure, treatment, test or device that We determine is not Medically Necessary. If an External Appeal Agent certified by the State overturns Our denial, however, We will Cover the service, procedure, treatment, test or device for which coverage has been denied, to the extent that such service, procedure, treatment, test or device, is otherwise Covered under the terms of this Contract.

  • Substance Abuse The dangers and costs that alcohol and other chemical abuses can create in the electrical contracting industry in terms of safety and productivity are significant. The parties to this Agreement resolve to combat chemical abuse in any form and agree that, to be effective, programs to eliminate substance abuse and impairment should contain a strong rehabilitation component. The local parties recognize that the implementation of a drug and alcohol policy and program must be subject to all applicable federal, state, and local laws and regulations. Such policies and programs must also be administered in accordance with accepted scientific principles, and must incorporate procedural safeguards to ensure fairness in application and protection of legitimate interests of privacy and confidentiality. To provide a drug-free workforce for the Electrical Construction Industry, each IBEW local union and NECA chapter shall implement an area-wide Substance Abuse Testing Policy. The policy shall include minimum standards as required by the IBEW and NECA. Should any of the required minimum standards fail to comply with federal, state, and/or local laws and regulations, they shall be modified by the local union and chapter to meet the requirements of those laws and regulations.

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