Preventive Care Services and Early Detection Services Sample Clauses

Preventive Care Services and Early Detection Services. In accordance with PPACA, this agreement provides coverage rendered to a member for early detection services, preventive care services, and immunizations/vaccinations as set forth below and in accordance with the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); or • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services (for example, pediatric preventive office visits), and adult and pediatric immunizations/vaccination are based on the most currently available guidelines and are subject to change. The amount you pay for early detection services, preventive care services, and adult and pediatric immunizations/vaccination is indicated in the Summary of Medical Benefits.
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Preventive Care Services and Early Detection Services for immunization and vaccination coverage information. We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.
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Preventive Care Services and Early Detection Services. In accordance with the guidelines established by the American Cancer Society (ACS) and in accordance with Rhode Island General Laws § 27-20-17 and § 27-20-44, this agreement provides coverage for early detection services (i.e., cancer screenings). The list of covered services is based on the most current ACS guidelines and is subject to change. In accordance with generally accepted standards of medical practice as recommended by agencies such as the United States Public Health Service, the US Preventive Services Task Force, and/or the American Academy of Pediatrics( for children and adolescents) , this agreement provides coverage for preventive care services. Covered preventive care services are based on the most currently available guidelines and are subject to change. The level of coverage for preventive care services and early detection services is based on the type of service, except for certain cancer screenings as mentioned below. For information regarding office visits see Section 3.24- Office Visits, for surgical procedures see Section 3.37 - Surgery Services, and for lab, radiology, and machine tests see Section 3.8 - Diagnostic Imaging, Lab, and Machine Tests, and for prescription drugs see Section 3.29 – Prescription Drugs. See the Summary of Benefits for benefit limits and level of coverage for each type of service. One pap smear annually is covered at the level of coverage for cancer screenings in the Summary of Benefits. The level of coverage for your second and subsequent pap smears is based on the type of service. For information regarding lab, radiology, and machine tests see Section 3.8 - Diagnostic Imaging, Lab, and Machine Tests. See the Summary of Medical Benefits for benefit limits and level of coverage. For the purpose of coverage under this agreement, the benefit limit and level of coverage listed in the Summary of Benefits for Preventive Care Services and Early Detection Services/ Cancer Screenings applies to specific cancer screenings. See the Summary of Benefits for the list of applicable cancer screenings. We cover adult preventive vaccinations/immunizations in accordance with current guidelines established by the Centers for Disease Control and Prevention (CDC), which are subject to change. Our allowance includes the administration and the vaccine. See the Summary of Benefits for benefit limits and level of coverage. If any of the above immunizations are provided as part of an office visit, only your office visit copayment and/...
Sample 1
Preventive Care Services and Early Detection Services. In accordance with PPACA, this agreement provides coverage rendered to a member for early detection services, preventive care services, and immunizations/vaccinations as set forth below and in accordance with the guidelines of the following resources:
Sample 1
Preventive Care Services and Early Detection Services. 3.30 • Cancer Screenings 3.30 The level of coverage for preventive care and early detection services is based on the type of service, with the exception of the cancer screenings mentioned below. See Section 3.30 for details. • Outpatient Hospital Facility 3.30 This level of coverage applies to the following cancer screenings: mammograms, pap smear, and PSA test. 100% coverage After deductible 80% coverage For information on other prevention services see Section 3.30. • Outpatient Non- Hospital facility 3.30 This level of coverage applies to the following cancer screenings: mammograms, pap smear, and PSA test. 100% coverage After deductible 80% coverage For information on other prevention services see Section 3.30. • Adult Immunizations 3.30 100% coverage After deductible 80% coverage • Pediatric Immunizations 3.30 100% coverage After deductible 80% coverage • Travel Immunizations 3.30 As recommended by the Centers for Disease Control and Prevention. 100% coverage After deductible 80% coverage Private Duty Nursing * 3.31 80% coverage After deductible 80% coverage** Radiation Therapy 3.32 • Inpatient 3.32 100% coverage After deductible 80% coverage • Outpatient 3.32 100% coverage After deductible 80% coverage Continued Summary of Medical Benefits See Important Note from First Page Type of Service Section Level of Coverage Benefit Limit Network Provider Non-Network Provider Respiratory Therapy 3.33 See program requirements in Section 3.33. 100% coverage After deductible 80% coverage Skilled Care in a Nursing Facility * 3.34 100% coverage After deductible 80% coverage Smoking Cessation Programs 3.35
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  • Administration Services When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

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