Common use of Outside of California Clause in Contracts

Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Rehabilitation — inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illnesses and Severe Emotional Disturbances of a Child, in order to restore an individual’s ability to function to the maximum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Benefits for Speech Therapy are described in the section on Speech Therapy Benefits. 1) have one or more mental disorders in the most recent edition of the Diagnostic and Statistical manual of Mental Disorders (other than a primary substance use disorder or developmental disorder), that results in behavior inappropriate for the child’s age according to expected developmental norms; and 2) meet the criteria in paragraph (2) of subdivision (a) of Section 5600.3 of the Welfare and Institutions Code. This section states that members of this population shall meet one or more of the following criteria: a) As a result of the mental disorder the child has substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or ability to function in the community: and either of the following has occurred: the child is at risk of removal from home or has already been removed from the home or the mental disorder and impairments have been present for more than 6 months or are likely to continue for more than one year without treatment; b) The child displays one of the following: psychotic features, risk of suicide or risk of violence due to a mental disorder. her Dependents has a 60-day Special Enrollment Period if any of the following occurs: 1) An individual or Dependent loses minimum essential coverage for a reason other than failure to pay premiums on a timely basis. 2) An individual or Dependent has lost or will lose coverage under an employer health benefit plan as a result of (a) termination of his or her employment; (b) termination of employment of the individual through whom he or she was covered as a Dependent; (c) change in his or her employment status or of the individual through whom he or she was covered as a Dependent, (d) termination of the other plan’s coverage, (e) exhaustion of COBRA or Cal-COBRA continuation coverage, (f) cessation of an employer’s contribution toward his or her coverage,

Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Rehabilitation — inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illnesses and Severe Emotional Disturbances of a Child, in order to restore an individual’s ability to function to the maximum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Benefits for Speech Therapy are described in the section on Speech Therapy Benefits. 1) have one or more mental disorders in the most recent edition of the Diagnostic and Statistical manual of Mental Disorders (other than a primary substance use disorder or developmental disorder), that results in behavior inappropriate for the child’s age according to expected developmental norms; and 2) meet the criteria in paragraph (2) of subdivision (a) of Section 5600.3 of the Welfare and Institutions Code. This section states that members of this population shall meet one or more of the following criteria: a) As a result of the mental disorder the child has substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or ability to function in the community: and either of the following has occurred: the child is at risk of removal from home or has already been removed from the home or the mental disorder and impairments have been present for more than 6 months or are likely to continue for more than one year without treatment; b) The child displays one of the following: psychotic features, risk of suicide or risk of violence due to a mental disorder. her Dependents has a 60-day Special Enrollment Period if any of the following occurs:. 1) An individual or Dependent loses minimum essential coverage for a reason other than failure to pay premiums on a timely basis. 2) An individual or Dependent has lost or will lose coverage under an employer health benefit plan as a result of (a) termination of his or her employment; (b) termination of employment of the individual through whom he or she was covered as a Dependent; (c) change in his or her employment status or of the individual through whom he or she was covered as a Dependent, (d) termination of the other plan’s coverage, (e) exhaustion of COBRA or Cal-COBRA continuation coverage, (f) cessation of an employer’s contribution toward his or her coverage,

Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Rehabilitation — inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illnesses and Severe Emotional Disturbances of a Child, in order to restore an individual’s ability to function to the maximum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Benefits for Speech Therapy are described in the section on Speech Therapy Benefits. 1) have one or more mental disorders in the most recent edition of the Diagnostic and Statistical manual of Mental Disorders (other than a primary substance use disorder or developmental disorder), that results in behavior inappropriate for the child’s age according to expected developmental norms; and 2) meet the criteria in paragraph (2) of subdivision (a) of Section 5600.3 of the Welfare and Institutions Code. This section states that members of this population shall meet one or more of the following criteria: a) As a result of the mental disorder the child has substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or ability to function in the community: and either of the following has occurred: the child is at risk of removal from home or has already been removed from the home or the mental disorder and impairments have been present for more than 6 months or are likely to continue for more than one year without treatment; b) The child displays one of the following: psychotic features, risk of suicide or risk of violence due to a mental disorder. her Dependents has a 60affective disorder, bipolar disorder (manic depressive illness), major depressive disorders, panic disorder, obsessive-day Special Enrollment Period if any of the following occurs:compulsive disorder, pervasive developmental disorder or autism, anorexia nervosa, bulimia nervosa. 1) An individual or Dependent loses minimum essential coverage for a reason other than failure to pay premiums on a timely basis. 2) An individual or Dependent has lost or will lose coverage under an employer health benefit plan as a result of (a) termination of his or her employment; (b) termination of employment of the individual through whom he or she was covered as a Dependent; (c) change in his or her employment status or of the individual through whom he or she was covered as a Dependent, (d) termination of the other plan’s coverage, (e) exhaustion of COBRA or Cal-COBRA continuation coverage, (f) cessation of an employer’s contribution toward his or her coverage,