Preventive Health Benefits Sample Clauses

Preventive Health Benefits. Preventive Care Services are those primary preventive medi- cal Services provided by a Physician for the early detection of disease when no symptoms are present and for those items specifically listed below. The specific benefits listed below for Preventive Care are not subject to the Calendar Year Deductible. No benefits are provided for Preventive Care Services pro- vided from Non-Preferred Providers. Note: Diagnostic audiometry examinations are covered under the Professional (Physician) Benefits.

Preventive Health Benefits. Preventive Health Services are only covered when provided or arranged by the Member’s Primary Care Physician. Preventive Health Services include primary pre- ventive medical and laboratory services for early detection of disease as specifically listed below:

Preventive Health Benefits. Each Insured is eligible to receive the following preventive services paid at 100% of the allowable charge when received from a Contracting Provider for preventive (i.e., not diagnostic or treatment) purposes. Preventive Health Services received from a Non-Contracting Provider will be subject to the cost-sharing requirements (including copayments, coinsurance and deductible), applicable hereunder, in a manner consistent with 42 U.S.C. 300gg-13 for: a. 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; b. immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; c. 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; and d. with respect to women, such additional preventive care and screenings not described in item (a) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph (including breast cancer screening and mammography screenings). A list of the preventive services covered under this section is available on our website at xxx.xxxxxx.xxx, or will be mailed to You upon request. You may request the list by calling the Customer Service number on Your Identification Card.

Preventive Health Benefits. Annual routine physical examination office visit: including physical examination office visit, routine eye/ear screening for members through age 18 and pediatric and adult immunizations and the immunization agent. Annual routine gynecological office visit: including the gynecological examination office visit, routine mammography, routine Papanicolaou (Pap)test or other FDA approved cervical cancer screening test, human papillomavirus (HPV) screening tests (One per calendar year) Routine laboratory services, including well baby laboratory services Well baby office visit: including well baby examination office visit, pediatric immunizations and the immunization agent, well baby vision and hearing screening No charge (Not subject to the Calendar-Year Deductible) No charge (Not subject to the Calendar-Year Deductible) No charge (Not subject to the Calendar-Year Deductible) No charge (Not subject to the Calendar-Year Deductible) Not covered 50%2 50%2 50%2 Outpatient surgery performed at an Ambulatory Surgery Center3 20% No charge12 (up to $350 per day maximum payment) Outpatient surgery in a hospital 20% No charge12 (up to $350 per day maximum payment) Outpatient Services for treatment of illness or injury and necessary supplies (Except as described under "Rehabilitation benefits") 20% 50%2 Outpatient X-ray, pathology and laboratory performed in a hospital3 20% 50%2, 12 (up to $350 per day maximum payment) Outpatient diagnostic testing performed in a hospital3 20% 50%2, 12 (up to $350 per day maximum payment) Bariatric Surgery (pre-authorization required; medically necessary surgery for weight loss, only for morbid obesity)4 20% No charge12 (up to $350 per day maximum payment) An Independent member of the Blue Shield Association Inpatient Physician Services 20% 50%2, 13 Inpatient Non-emergency Facility Services (Semi-private room and board, medically necessary services and supplies) 20% No charge12 (up to $600 per day maximum payment) Bariatric Surgery (pre-authorization required; medically necessary surgery for weight loss, only for morbid obesity)4 20% No charge12 (up to $600 per day maximum payment) Services by a free-standing Skilled Nursing Facility 20% 20%6 Skilled Nursing Unit of a Hospital 20% No charge12 (up to $600 per day maximum payment) Emergency room Services not resulting in admission $100 per visit + 20% $100 per visit + 20% Emergency room Services resulting in admission (When the member is admitted directly from the ER) 20% 20% Emergency room P...

Preventive Health Benefits. Preventive Health Services are only covered when provided or arranged by the Member’s Personal Physician. xxx.xxxxxxxxxxxx.xxx/xxxxxxxxxx or by calling Customer Service. In the event there is a new recommendation or guideline in any of the resources described in items 1) through 4) above, the new recommendation will be covered as a Preventive Health Service no later than 12 months following the issuance of the rec- ommendation.

Preventive Health Benefits. Preventive Health Services include primary preventive medical screening and laboratory testing for early detection of disease as specifically listed below: