Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), including screening colonoscopy or sigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means physician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)(xxx.xxxx.xxx). Benefits defined under the Health Resources and Services Administration (HRSA) requirement include: • Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care Physician, if you have any questions or need assistance locating a provider for these services. • One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost effective pump. We will determine the following: Which pump is the most cost effective. Whether the pump should be purchased or rented. Timing of purchase or rental.
Appears in 1 contract
Samples: Individual Medical Policy
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), including screening colonoscopy or sigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (xxx.xxxx.xxxHRSA)(xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means physicianPhysician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)(xxx.xxxx.xxxHRSA) (xxx.xxxx.xxx). ▪ Benefits defined under the Health Resources and Services Administration (HRSA) requirement include: • ♦ Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care PhysicianProvider, if you have any questions or need assistance locating a provider for these services. • ♦ One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx or the telephone number on your ID card. 🢒 If more than one breast pump can meet your needs, Benefits are available only for the most cost effective pump. We will determine the following: − Which pump is the most cost effective. − Whether the pump should be purchased or rentedrented (and the duration of any rental). − Timing of purchase or rental. SAMPLE • Fitness Benefit. We will reimburse you for your costs for monthly membership fees for three consecutive months of one family or individual health club membership at a qualified health club during a calendar year. You can claim this fitness benefit once each calendar year. This fitness benefit applies for fees paid to: qualified health clubs which must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment. Examples of qualified health clubs include (but are not limited to): YMCA, YWCA, LA Fitness, Bally’s, Life Time Fitness, Boost Fitness, Best Fitness and community Fitness Centers. Please note that non-qualified health club memberships are not eligible for reimbursement. • Weight Loss Program Benefit. We will reimburse you for your costs for up to three months for participation in qualified weight loss program(s) each calendar year. A qualified weight loss program is a hospital-based weight loss program or a non-hospital-based weight loss program designated by us. You can claim this one-twelve-month weight loss program benefit once each calendar year for any combination of members (such as the subscriber, spouse, and/or dependent children). Examples of qualified weight loss programs include (but are not limited to): The Weight Watchers Traditional, Weight Watchers at Work programs, Weight Watchers Online and hospital- based weight loss programs offered by and held at licensed hospitals qualify for reimbursement. ▪ To receive your fitness program and/or weight loss program benefit, you must file a claim. To file a claim, you must: fill out a claim form; attach your original itemized paid receipt(s); and mail the claim to us at: ▪ For a claim form or help to file a claim, you can call us at the telephone number shown on your ID card.
Appears in 1 contract
Samples: Individual Medical Policy
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), including screening colonoscopy or sigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC)(xxx.xxx.xxx). • Sample With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (xxx.xxxx.xxxHRSA)(xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means physicianPhysician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical examexamination, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)(xxx.xxxx.xxxHRSA) (xxx.xxxx.xxx). Benefits defined under the Health Resources and Services Administration (HRSA) requirement include: • ♦ Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care PhysicianProvider, if you have any questions or need assistance locating a provider for these services. • ♦ One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost effective pump. We will determine the following: Which pump is the most cost effective. Whether the pump should be purchased or rentedrented (and the duration of any rental). Timing of purchase or rental. Fitness Benefit. We will reimburse you for your costs for monthly membership fees for three consecutive months of one family or individual health club membership at a qualified health club during a calendar year. You can claim this fitness benefit once each calendar year. This fitness benefit applies for fees paid to: qualified health clubs which must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment. Examples of qualified health clubs include (but are not limited to): YMCA, YWCA, LA Fitness, Bally’s, Life Time Fitness, Boost Fitness, Best Fitness and community Fitness Centers. Please note that non-qualified health club memberships are not eligible for reimbursement. Weight Loss Program Benefit. We will reimburse you for your costs for up to three months for participation in qualified weight loss program(s) each calendar year. A qualified weight loss program is a hospital- based weight loss program or a non-hospital-based weight loss program designated by us. You can claim this one-twelve-month weight loss program benefit once each calendar year for any combination of members (such as the subscriber, spouse, and/or dependent children). Examples of qualified weight loss programs include (but are not limited to): The Weight Watchers Traditional, Weight Watchers at Work programs, Weight Watchers Online and hospital-based weight loss programs offered by and held at licensed hospitals qualify for reimbursement. To receive your fitness program and/or weight loss program benefit, you must file a claim. To file a claim, you must: fill out a claim form; attach your original itemized paid receipt(s); and mail the claim to us at: For a claim form or help to file a claim, you can call us at the telephone number shown on your ID card.
Appears in 1 contract
Samples: Individual Medical Policy
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), including screening colonoscopy or sigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (xxx.xxxx.xxxHRSA)(xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means physicianPhysician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)(xxx.xxxx.xxxHRSA) (xxx.xxxx.xxx). Benefits defined under the Health Resources and Services Administration (HRSA) requirement include: • ♦ Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care PhysicianProvider, if you have any questions or need assistance locating a provider for these services. • ♦ One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost effective pump. We will determine the following: − Which pump is the most cost effective. − Whether the pump should be purchased or rentedrented (and the duration of any rental). − Timing of purchase or rental. Sample • Fitness Benefit. We will reimburse you for your costs for monthly membership fees for three consecutive months of one family or individual health club membership at a qualified health club during a calendar year. You can claim this fitness benefit once each calendar year. This fitness benefit applies for fees paid to: qualified health clubs which must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment. Examples of qualified health clubs include (but are not limited to): YMCA, YWCA, LA Fitness, Bally’s, Life Time Fitness, Boost Fitness, Best Fitness and community Fitness Centers. Please note that non-qualified health club memberships are not eligible for reimbursement. • Weight Loss Program Benefit. We will reimburse you for your costs for up to three months for participation in qualified weight loss program(s) each calendar year. A qualified weight loss program is a hospital-based weight loss program or a non-hospital-based weight loss program designated by us. You can claim this one-twelve-month weight loss program benefit once each calendar year for any combination of members (such as the subscriber, spouse, and/or dependent children). Examples of qualified weight loss programs include (but are not limited to): The Weight Watchers Traditional, Weight Watchers at Work programs, Weight Watchers Online and hospital- based weight loss programs offered by and held at licensed hospitals qualify for reimbursement. To receive your fitness program and/or weight loss program benefit, you must file a claim. To file a claim, you must: fill out a claim form; attach your original itemized paid receipt(s); and mail the claim to us at: For a claim form or help to file a claim, you can call us at the telephone number shown on your ID card.
Appears in 1 contract
Samples: Individual Medical Policy
