Outpatient Medical Care Services. Medical care rendered by a Professional Provider to a Member who is an Outpatient for a condition not related to Surgery, pregnancy or Mental Illness, except as specifically provided, including allergy extracts, allergy injections, medical care Visits, Telemedicine Services, therapeutic injections and consultations for the examination, diagnosis and treatment of an injury or illness, and Covered Services provided by Professional Providers at a Retail Clinic or Urgent Care Center. However, benefits for certain therapeutic injectables as identified by the Plan and which are appropriate for self- administration will be provided only when received from a Participating Pharmacy Provider as set forth under Subsection Q. OUTPATIENT PRESCRIPTION DRUGS of this Section. Benefits are also provided for a Specialist Virtual Visit which is subsequent to the Member’s initial Visit with his or her treating Specialist for the same condition. The Provider based location from which the Member communicates with the Specialist is referred to as the “originating site”. Benefits for Outpatient Medical Care Services will be provided in the amounts specified in SECTION SB - SCHEDULE OF BENEFITS of this Agreement and are subject to additional limitations outlined in that Section.
Appears in 6 contracts
Samples: Individual Comprehensive Major Medical Exclusive Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement
Outpatient Medical Care Services. Medical care rendered by a Professional Provider to a Member who is an Outpatient for a condition not related to Surgery, pregnancy or Mental Illness, except as specifically provided, including allergy extracts, allergy injections, medical care Visits, Telemedicine Services, therapeutic injections and consultations for the examination, diagnosis and treatment of an injury or illness, and Covered Services provided by Professional Providers at a Retail Clinic or Urgent Care Center. However, benefits for certain therapeutic injectables as identified by the Plan and which are appropriate for self- administration will be provided only when received from a Participating Pharmacy Provider as set forth under Subsection Q. OUTPATIENT PRESCRIPTION DRUGS of this Section. Benefits are also provided for a Specialist Virtual Visit which is subsequent to the Member’s initial Visit with his or her treating Specialist for the same condition. The Provider based location from which the Member communicates with the Specialist is referred to as the “originating site”. Benefits for Outpatient Medical Care Services will be provided in the amounts specified in SECTION SB - SCHEDULE OF BENEFITS of this Agreement and are subject to additional limitations outlined in that Section.
Appears in 3 contracts
Samples: Individual Comprehensive Major Medical Preferred Provider Qualified High Deductible Health Plan Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Qualified High Deductible Health Plan Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Qualified High Deductible Health Plan Subscription Agreement
