Physical, Occupational and Speech Therapy Sample Clauses

Physical, Occupational and Speech Therapy. The Company will implement a copay of $20 for each outpatient physical, occupational and speech therapy visit on an in-network basis. Outpatient physical, occupational and speech therapy facility charges will be covered after the deductible is met on an in-network basis at 90% of the NNF. Provider and facility charges for outpatient physical, occupational and speech therapy will be covered on an out-of-network basis at 60% of the MAA after the deductible is met. (Amend the following sections of the VMEP: Sections 6.1.2, 6.1.3 and 9.13.)

Physical, Occupational and Speech Therapy. Provider and facility charges for outpatient physical, occupational and speech therapy will be covered on an out-of-network basis at 60% of the MAA after the deductible is met. (Amend the following sections of the FMEP: Section 5.2.3.)

Physical, Occupational and Speech Therapy. Provider and facility charges for outpatient physical, occupational and speech therapy will be covered at 90% after the deductible is met. The Company will have the full discretionary authority to determine and implement applicable administrative details with respect to the Medicare Advantage plan(s) without diminishing the medical benefits then offered under such plan(s) unless required by applicable law. The Company may also modify the terms of the medical options offered under the Medicare Advantage plan(s) (including, but not limited to, plan design) to the extent necessary to comply with legal requirements applicable to Medicare Advantage plans; provided that such modifications shall be made in a manner most favorable to Covered Retirees. In an effort to educate Medicare-eligible Covered Retirees and dependents about the Medicare Advantage plan, the Company and/or the insurer(s) or TPA(s) of the Medicare Advantage plan will conduct a pre-implementation education and communication program, which will consist of direct written communications to Medicare-eligible Covered Retirees and dependents and educational webinars. This education and communication program will commence no later than 90 days prior to the date the Medicare Advantage plan is implemented. The Company and/or the insurer(s) or TPA(s) will bear the cost of such program. The Company agrees to discuss the education and communication program with the ACHC. In addition, the Company, the insurers(s) and/or TPA(s) of the Medicare Advantage plan will from time to time conduct a satisfaction survey of the Medicare-eligible Covered Retirees and dependents enrolled in the Medicare Advantage plan and the Company will provide the ACHC with a report summarizing the results of such surveys. If a Company-sponsored Medicare Advantage plan has become financially less favorable than offering the design provisions of the Company-sponsored medical options that would have otherwise been offered on a self-insured basis to Medicare-eligible Covered Retirees and dependents or is no longer feasible as a result of a change in the applicable law or regulations, the Company will terminate the Medicare Advantage plan options and offer medical coverage to such Covered Retirees and dependents under one or more Company-sponsored medical plans that substantially mirror the medical plan design that exists within the Medicare Advantage plan option at the time of its termination and that coordinates with Medicare.

Physical, Occupational and Speech Therapy. Services If, in the judgment of a Plan Physician, significant improvement is achievable within a ninety (90)-day period, we cover physical, occupational and speech therapy that is provided: 1. In a Plan Medical Center; 2. In a Plan Provider’s medical office; 3. In a Skilled Nursing Facility or as part of home health care per calendar year per injury, incident or condition; 4. Via Video visits; or 5. While confined in Plan Hospital. Refer to the Summary of Services and Cost Shares for visit limitations for Physical, Occupational, and Speech Therapy Services. The limits do not apply to necessary treatment of cleft lip or cleft palate. Note: Speech therapy includes Services necessary to improve or teach speech, language, or swallowing skills, which results from disease, surgery, injury, congenital anatomical anomaly, or prior medical treatment and will treat communication or swallowing difficulties to correct a speech impairment. Multidisciplinary Rehabilitation Services If, in the judgment of a Plan Physician, significant improvement is achievable within a two (2)-month period, we cover multidisciplinary rehabilitation Services in a Plan Hospital, Plan Medical Center, Plan Provider’s medical office, or a Skilled Nursing Facility. Coverage is limited to a maximum of two (2) consecutive months of treatment per injury, incident or condition. Multidisciplinary rehabilitation Service programs mean inpatient or outpatient day programs that incorporate more than one (1) therapy at a time in the rehabilitation treatment. Xxxxxxx Rehabilitation Services We cover outpatient cardiac rehabilitation Services that is Medically Necessary following coronary surgery or a myocardial infarction, for up to twelve (12) weeks, or thirty-six (36) sessions, whichever occurs first. Cardiac rehabilitation Services must be provided or coordinated by a facility approved by the Health Plan, and that offers exercise stress testing, rehabilitative exercises and education and counseling. See the benefit-specific limitations and exclusions immediately below for additional information.

Physical, Occupational and Speech Therapy. Services If, in the judgment of a Plan Physician, measurable improvement in functional capabilities are achievable within a ninety (90)-day period, we cover physical, occupational and speech therapy that is provided: 1. In a Plan Medical Center; 2. In a Plan Provider’s medical office; 3. In a Skilled Nursing Facility or as part of home health care per calendar year per injury, incident or condition.

Physical, Occupational and Speech Therapy. The Company will implement a $20 copay for evaluations for outpatient physical, occupational and speech therapy on an in-network basis. The copay for an individual who is eligible for Medicare will be $10 on an in-network basis. Outpatient physical, occupational and speech therapy visits and services will be covered on an in-network basis at 90% of the NNF. Charges for outpatient physical, occupational and speech therapy visits and services will be covered on an out-of-network basis at 70% of the MAA after the deductible is met. (Amend the following sections of the VMEP: Sections 5.1.2, 5.1.3 and 8.14.)

Physical, Occupational and Speech Therapy. 1. Short-term physical therapy, speech therapy, and occupational therapy prescribed by a Physician are provided for those conditions which meet all of the following criteria: a. The therapy is ordered by a Physician under an individual treatment plan. b. In the judgment of a Physician, the condition is subject to significant, measurable improvement in physical function with short-term therapy. c. The therapy is provided by or under the supervision of a Physician-designated licensed physical, speech, or occupational therapist, as appropriate. d. As determined by a Physician, the therapy must be necessary to sufficiently restore neurological and/or musculoskeletal function that was lost or impaired due to an illness or injury. Neurological and/or musculoskeletal function is sufficient when one of the following first occurs: i) neurological and/or musculoskeletal function is the level of the average healthy person of the same age, ii) further significant functional gain is unlikely, or iii) the frequency and duration of therapy for a specific medical condition as sxxxxxxed in Kaiser Permanente Hawaii’s Clinical Practice Guidelines has been reached. 2. While Hospitalized, in a Skilled Nursing Facility, or receiving home health care. During hospitalization specified in section B, or while receiving Skilled Nursing Care specified in section K, prescribed short-term physical therapy, occupational therapy and speech therapy are included in the Supplemental Charges specified in the aforementioned benefit sections. While receiving home health care specified in section L-1, prescribed short-term physical therapy, occupational therapy, and speech therapy are provided without charge. 3. In Medical Offices. Prescribed short-term physical therapy, occupational therapy, and speech therapy are provided in the Medical Offices upon payment of a $20.00 Supplemental Charge per visit.