Preventive Health Care Services Sample Clauses

Preventive Health Care Services. The Preventive Health Care Services will be provided to MEMBERS by designated MediCard Medical Service Units.
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Preventive Health Care Services a. See all exclusions.* b. Preventive health care services received from a non-participating provider. c. Any health care services performed during or in conjunction with an annual or periodic wellness exam that exceeds the services described in the Preventive Health Care Services section of this contract. d. Routine eye examinations, except as otherwise covered under this contract e. Electronic cigarettes, e-cigarettes, personal vaporizers, and similar forms of nicotine delivery systems. f. Tobacco cessation intervention programs and related health care services, except as covered under the “Preventive Health Care Services” section of this contract. g. Non-prescribed over-the-counter medications. 77. Reconstructive Surgery: a. See all exclusions.* b. Health care services to treat conditions that are cosmetic in nature, including preoperative procedures and any medical or surgical complications arising therefrom, except for emergency services as required under Minnesota Statute 62Q.55 that are the result of complications of an excluded cosmetic surgery and for which coverage is provided under the “Emergency Services” section of this contract.
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Preventive Health Care Services. We cover the following preventive Services without any Cost Sharing requirements, such as Deductibles, Copayment amounts or Coinsurance amounts to any Member receiving any of the following benefits for Services from Plan Providers: 1. Evidenced-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, except that the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention of breast cancer shall be considered the most current other than those issued in or around November 2009 (To see an updated list of the USPSTF “A” or “B” rated services. Visit xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx); 2. 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 (Visit the Advisory Committee on Immunization Practices at xxxx://xxx.xxx.xxx/vaccines/acip/index.html); 3. 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. Visit HRSA at xxxx://xxxx.xxxx.xxx); and 4. With respect to women, such additional preventive care and screenings, not described in paragraph 1 above, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Visit HRSA at xxxx://xxxx.xxxx.xxx). The Health Plan shall update new recommendations to the preventive benefits listed above at the schedule established by the Secretary of Health and Human Services. We cover medically appropriate preventive health care Services based on your age, sex, or other factors, as determined by your primary care Plan Physician in accordance with national preventive health care standards. These Services include the exam, screening tests and interpretation for: 1. Preventive care exams, including: a. Routine physical examinations and health screening tests appropriate to your age and sex; b. Well-woman examinations; and c. Well child care examinations. 2. Routine and necessary immunizations (travel immunizations are not preventive and are covered under Outpatient Services in this section) for children and adults in accordance with Plan guidelines. Childhood immunizations include diphtheria, pertussis, tetanus, polio, hepat...
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Preventive Health Care Services a. See all exclusions.* b. Preventive health care services received from a non-participating provider. c. Any health care services performed during or in conjunction with an annual or periodic wellness exam that exceeds the services described in the Preventive Health Care Services section of this contract. d. Routine eye examinations, except as otherwise covered under this contract e. Electronic cigarettes, e-cigarettes, personal vaporizers, and similar forms of nicotine delivery systems. f. Tobacco cessation intervention programs and related health care services, except as otherwise covered under this g. Non-preventive health care services are not covered under this section of this contract. h. Non-routine health care services, including but not limited to non-routine prenatal services, are not covered under the “Preventive Health Care Services” section of this contract.
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Preventive Health Care Services. Covered Benefits include preventive health care services by a Participating Provider for the following in accordance with the A or B recommendations of the task force for the particular preventive health care service: • Alcohol Misuse screening and behavioral counseling interventions for adults by a PCP; Please refer to the Summary of Coverage for the Maximums Visits under this section. Any subsequent mammography performed may be subject to the plan’s Deductible or coinsurance provisions same as any other diagnostic service. Not withstanding the A or B recommendations of the task force, an annual breast cancer screening with mammography is covered for all Members possessing at least one risk factor including, but not limited to: • Colorectal Cancer Screening tests for the early detection of colorectal cancer and adenomatous polyps or a Member who is at a high risk for colorectal cancer including Members who have a family medical history of o colorectal cancer;
Sample 1
Preventive Health Care Services. We cover medically appropriate preventive health Care Services based on your age, sex or other factors, as determined by your Primary Care Plan Physician in accordance with national preventive health care standards. These Services include the exam, screening tests and interpretation for: 1. Preventive care exams, including: a. Routine physical examinations and health screening tests appropriate to your age and sex; b. Well-woman examinations, including visits to obtain necessary preventive care, and preconception care and prenatal care; and c. Well child care examinations; 2. Routine and necessary immunizations (travel immunizations are not preventive and are covered under Outpatient Care) for children and adults in accordance with Plan guidelines. Childhood immunizations include diphtheria, pertussis, tetanus, polio, hepatitis B, measles, mumps, rubella and other immunizations as may be prescribed by the Commissioner of Health; 3. An annual pap smear, including coverage for any FDA-approved gynecologic cytology screening technology; 4. Low dose screening mammograms, including 3-D mammograms to determine the presence of breast disease is covered as follows: a. One mammogram for persons age 35 through 39; b. One mammogram biennially for persons age 40 through 49; and c. One mammogram annually for person 50 or older; 5. Adjuvant breast cancer screening, including magnetic resonance imaging (MRI), ultrasound, screening, or molecular breast imaging of the breast, if: a. A mammogram demonstrates a Class C or Class D breast density classification; or b. A woman is believed to be at an increased risk for cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications of an increased risk for cancer as determined by a woman’s physician or advanced practice registered nurse.
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Preventive Health Care Services. The services of licensed health care professionals which are provided on an outpatient basis, including routine well-child visits; diagnosis and treatment of illness and injury; laboratory tests; diagnostic x-rays; prescription drugs; radiation therapy; chemotherapy; hemodialysis; emergency room services; and outpatient alcohol and substance abuse services. A licensed health professional responsible for performing or directly supervising the primary care services of Members.
Sample 1
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Preventive Health Care Services. We cover medically appropriate preventive health care Services based on your age, sex, or other factors, as determined by your primary care Plan Physician pursuant to national preventive health care standards. These Services include the exam, screening tests and interpretation for: 1. Preventive care exams, including: a. Routine physical examinations and health screening tests appropriate to your age and sex; b. Well-woman examinations; and c. Well child care examinations; 2. Routine and necessary immunizations (travel immunizations are not preventive and are covered under Outpatient Services in this section) for children and adults in accordance with Plan guidelines. Childhood immunizations include diphtheria, pertussis, tetanus, polio, hepatitis B, measles, mumps, rubella and other immunizations as may be prescribed by the Commissioner of Health; 3. An annual pap smear, including coverage for any FDA-approved gynecologic cytology screening technology; 4. Low dose screening mammograms to determine the presence of breast disease is covered as follows: a. One mammogram for persons age 35 through 39; b. One mammogram biennially for persons age 40 through 49; and c. One mammogram annually for person 50 and over; 5. Bone mass measurement to determine risk for osteoporosis; 6. Prostate Cancer screening including diagnostic examinations, digital rectal examinations, and prostate antigen (PSA) tests provided to men who are age 40 or older; 7. Colorectal cancer screening in accordance with screening guidelines issued by the American Cancer Society including fecal occult blood tests, flexible sigmoidoscopy, and screening colonoscopy; 8. Cholesterol test (lipid profile); 9. Diabetes screening (fasting blood glucose test); 10. Sexually Transmitted Disease (STD) tests (including chlamydia, gonorrhea, syphilis and HPS), subject to the following: a. Annual chlamydia screening is covered for (a) women under age of 20, if they are sexually active; and (b) women age 20 years of age or older, and men of any age, who have multiple risk factors, which include: (i) a prior history of sexually transmitted diseases; (ii) new or multiple sex partners; (iii) inconsistent use of barrier contraceptives; or (iv) cervical ectopy; b. Human Papillomavirus Screening (HPS) as recommended for cervical cytology screening by the American College of Obstetricians and Gynecologists; 11. HIV tests; 12. TB tests; 13. Newborn hearing screenings that include follow up audiological examinations, as...
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Preventive Health Care Services where they are referred to in this agreement are defined as non-curative health services provided to the student by parental consent (unless otherwise allowed by current Georgia law for Confidential Services). These services will follow preventive guidelines and may include: • Health screening (e.g. Early Periodic Screening and Diagnostic Testing (EPSDT) screening) • Disease prevention (e.g. immunizations, communicable diseases, etc) • Dental services (exam, x-ray, prophy (cleaning) and sealant when indicated) • Preventive services and education such as nutritional education, mental health screening and high risk assessments and health maintenance.
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Related to Preventive Health Care Services

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • 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

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

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

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Preventive Services All necessary procedures to prevent the occurrence of oral disease, including: Cleaning and scaling Topical application of fluoride Space maintainers

  • Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

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