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. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs 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 PPACA, this agreement provides coverage rendered to a subscriber for early detection services, preventive care services, and immunizations/vaccinations as set forth in 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); and • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services, and adult and pediatric immunizations/vaccination are based on the most currently available guidelines and are subject to change. The level of coverage for early detection services, preventive care services, and adult and pediatric immunizations/vaccination is indicated in the Summary of Medical Benefits One pap smear annually is covered at the level of coverage for early detection services as shown in the Summary of Benefits. The level of coverage for your second and subsequent pap smear is covered as a lab test. For information about lab, radiology, and machine tests see Section 3.8 - Diagnostic Imaging, Lab, and Machine Tests. Vaccinations/Immunizations Adult Vaccinations/Immunizations We cover adult preventive vaccinations and immunizations in accordance with current guidelines. These guidelines are subject to change. Our allowance includes the administration and the vaccine. If any of the above immunizations are provided as part of an office visit, only your office visit copayment and deductible (if any) will be applied. If your doctor administers any of the above immunizations and vaccinations in the absence of an office visit, the immunization and vaccination is covered up to the benefit level shown in the Summary of Medical Benefits.
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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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Related to Preventive Care Services and Early Detection Services

  • Prevention Care Services and Early Detection Services See Prevention and Early Detection Services section for details. 0% Not Covered Private Duty Nursing Services* Must be performed by a certified home health care agency. 0% - After deductible Not Covered

  • Preventive Care and Early Detection Services This plan covers, early detection services, preventive care services, and immunizations or vaccinations in accordance with state and federal law, including the Affordable Care Act (ACA), 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 and adult and pediatric immunizations or vaccinations are based on the most currently available guidelines and are subject to change. The amount you pay for preventive services will be different from the amount you pay for diagnostic procedures and non-preventive services. See the Summary of Medical Benefits and the Summary of Pharmacy Benefits for more information about the amount you pay. Preventive Office Visits This plan covers the following preventive office visits. • Annual preventive visit - one (1) routine physical examination per plan year per member age 36 months and older; • Pediatric preventive office and clinic visits from birth to 35 months - 11 visits; • Well Woman annual preventive visit - one (1) routine gynecological examination per plan year per female member.

  • Urgent Care Services All Medically Necessary Covered Services received in Urgent Care Centers, Retail Clinics or your Primary Care Physician’s office after-hours to treat an Urgent Medical Condition will be covered by AvMed. Any request for reimbursement of payment made by a Member for services received must be filed within 90 days or as soon as reasonably possible but not later than one year unless the Member was legally incapacitated. If Urgent Medical Services and Care are required while outside the continental United States, Alaska or Hawaii, it is the Member’s responsibility to pay for such services at the time they are received. For information on filing a Claim for such services, see Part XIII. REVIEW PROCEDURES AND HOW TO APPEAL A CLAIM (BENEFIT) DENIAL.

  • Collection Services 5.01 General 5-1 5.02 Solid Waste Collection 5-1 5.03 Targeted Recyclable Materials Collection 5-3

  • Emergency Care Services If you experience a medical emergency while traveling outside our service area, go to the nearest emergency or urgent care facility. When you receive Out-of-Area covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for the Out-of-Area Covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: • the billed charges for your Out-of-Area covered healthcare services; or • the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.

  • Interconnection Customer Provided Services The services provided by Interconnection Customer under this LGIA are set forth in Article 9.6 and Article 13.5.1. Interconnection Customer shall be paid for such services in accordance with Article 11.6.

  • Information Services Traffic 5.1 For purposes of this Section 5, Voice Information Services and Voice Information Services Traffic refer to switched voice traffic, delivered to information service providers who offer recorded voice announcement information or open vocal discussion programs to the general public. Voice Information Services Traffic does not include any form of Internet Traffic. Voice Information Services Traffic also does not include 555 traffic or similar traffic with AIN service interfaces, which traffic shall be subject to separate arrangements between the Parties. Voice Information services Traffic is not subject to Reciprocal Compensation as Local Traffic under the Interconnection Attachment.

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Education services 1.1 Catholic education is intrinsic to the mission of the Church. It is one means by which the Church fulfils its role in assisting people to discover and embrace the fullness of life in Xxxxxx. Catholic schools offer a broad, comprehensive curriculum imbued with an authentic Catholic understanding of Xxxxxx and his teaching, as well as a lived appreciation of membership of the Catholic Church. Melbourne Archdiocese Catholic Schools Ltd (MACS) governs the operation of MACS schools and owns, governs and operates the School.

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