Preventive Care Clause Samples

Preventive Care. This plan covers preventive care as described below. “

Preventive Care. Group shall have sole responsibility for --------------- all preventive care intended to delay, or intercept the development of pathologic conditions.

Preventive Care.  Drugs to treat infertility, to enhance fertility or to treat sexual dysfunction  Weight management drugs or drugs for the treatment of obesity  Replacement of lost or stolen medication

Preventive Care. Preventive care means: Evidence based items or services that are rated “A” or “B” in the current recommendations of the United States Preventive Services task Force with respect to the Member; Immunizations for routine use for Members of all ages as recommended by the Advisory Committee on Immunization Practices of the Centers of Disease Control and Prevention with respect to the Member; Evidence–informed preventive care and screenings for Members who are infants, children and adolescents, as included in the comprehensive guidelines supported by the Health Resources and Services Administration; Evidence–informed preventive care and screenings for Members as included in the comprehensive guidelines supported by the Health Resources and Services Administration; and Any other evidence-based or evidence-informed items as determined by federal and/or state law. Examples of preventive care include, but are not limited to: routine physical examinations, including related laboratory tests and x-rays, immunizations and vaccines, well baby care, pap smears, mammography, screening tests, bone density tests, colorectal cancer screening, prostate cancer screening, and Nicotine Dependence Treatment.

Preventive Care. The Plan does not provide Benefits for preventive care and well-care services, unless otherwise stated in this Agreement in Sections 4.B and 2.

Preventive Care. Preventive care means care and services to avert disease/illness and/or its consequences. There are three (3) levels of preventive care: 1) primary, such as immunizations, aimed at preventing disease; 2) secondary, such as disease screening programs aimed at early detection of disease; and 3) tertiary, such as physical therapy, aimed at restoring function after the disease has occurred. Commonly, the term "preventive care" is used to designate prevention and early detection programs rather than restorative programs. The following preventive services are also included in the managed care Benefit Package. These preventive services are essential for promoting wellness and preventing illness. MCOs must offer the following: - General health education classes. - Pneumonia and influenza immunizations for at risk populations. - Smoking cessation classes, with targeted outreach for adolescents and pregnant women. - Childbirth education classes. - Parenting classes covering topics such as bathing, feeding, injury prevention, sleeping, illness prevention, steps to follow in an emergency, growth and development, discipline, signs of illness, etc.

Preventive Care. Children’s eye exam. For more information see below. This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/coverage/preventive-care-benefits/. Are there other deductibles for specific services? No. You don't have to meet deductibles for specific services. What is the out-of- pocket limit for this plan? $2,000/person or $4,000/family for In-Network Providers. $4,000/person or $8,000/family for Non-Network Providers. The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, the overall family out-of-pocket limit must be met. What is not included in the out-of-pocket limit? Premiums, balance-billing charges, health care this plan doesn't cover, and Non-Network Transplants. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Will you pay less if you use a network provider? Yes. See ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇- care/?alphaprefix=AZL or call (▇▇▇) ▇▇▇-▇▇▇▇ for a list of network providers. Costs may vary by site of service and how This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services. the provider bills. Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral. All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. In-Network Provider (You will pay the least) Non-Network Provider (You will pay the most) If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness 0% coinsurance 20% coinsurance Virtual visits (Telehealth) benefits available. Specialist visit 0% coinsurance 20% coinsurance Virtual visits (Telehealth) benefits available. Preventive care/screening/ immunization No charge 20% coinsurance You may have to pay for services that aren't preventive. Ask yo...

Preventive Care. Prescription and over-the-counter drugs which have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (“USPSTF”) (to be implemented in the quantities and within the time period allowed under applicable law) or as required by state law will be covered and will not be subject to any Copayment or dollar maximums. Formulas for the Treatment of Phenylketonuria or Other Heritable Diseases. Dietary formulas necessary for the treatment of phenylketonuria or other heritable diseases are covered to the same extent as any other Covered Drug available only on the orders of a Health Care Practitioner. Amino Acid-Based Elemental Formulas. Formulas, regardless of the formula delivery method, used for the diagnosis and treatment of: Orally Administered Anticancer Medication. Benefits are available for Medically Necessary orally administered anticancer medication that is used to kill or slow the growth of cancerous cells. Copayments will not apply to certain orally administered anticancer medications. To determine if a specific drug is included in this benefit, contact customer service at the toll-free number on Your identification card. Selecting a Pharmacy

Preventive Care. Routine Well Adult Care 100% 60% after deductible Includes: office visits, pap smear, mammogram, gynecological exam, routine physical examination, x- rays, laboratory tests, prostate specific antigen test, colonoscopies, sigmoidoscopies and anoscopy, proctosigmoidoscopy, medical tests and other preventive services as required by law. Routine Well Child Care 100% 60% after deductible Includes: office visits, routine physical examination, laboratory tests, x-rays, immunizations, and other Preventive services as required by law. Flu Shots 100% Paid Same As Network Eye Exam (including refractive exams) 100% after Copayment Limited to 1 per Calendar Year, unless otherwise required by law Not Covered Organ Transplants 80% after deductible Not Covered Other Medical Services and Supplies 80% after deductible 60% after deductible Drugs and Products included on the Select Drugs and Products List Require pre-certification and enrollment in the Select Drugs and Products Program Generic Drugs $10 copayment Formulary Brand Name Drugs $20 copayment Non-Formulary Brand Name Drugs $50 copayment Specialty Drugs May be available through the Select Drugs and Products Program Generic Drugs $20 copayment Formulary Brand Name Drugs $40 copayment Non-Formulary Brand Name Drugs $100 copayment NOTE: Charges for Prescription Drugs obtained through the Prescription Drug Benefit section will not apply to the Calendar Year Deductible. Prescription Drug expenses do apply to the Out-of-Pocket Maximum under Medical Benefits section of this Plan. Per Covered Person $2,800 $5,000 Per Family Unit $5,000 $10,000 Amounts applied to the Network Deductible and the Non-Network Deductible do not cross-apply. The Calendar Year deductible is waived for the following Covered Charges: - Network Preventive Care - Flu Shots Per Covered Person $2,800 $6,000 Per Family Unit $5,000 $12,000 The Plan will pay the designated percentage of Covered Charges until out-of-pocket amounts are reached, at which time the Plan will pay 100% of the remainder of Covered Charges for the rest of the Calendar Year unless stated otherwise. The following charges do not apply toward the out-of-pocket maximum: Non-Precertification penalties Amounts over Usual and Reasonable Charge Amounts for products included on the Select Drugs and Products List Room, Board, and Miscellaneous Expenses 100% after deductible 80% after deductible Intensive Care Unit 100% after deductible 80% after deductible Surgical Facilities 100% after deduct...