Reconstructive Surgery Benefits Sample Clauses

Reconstructive Surgery Benefits. Benefits are available for Reconstructive Surgery services. Benefits include: • Surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to: o Improve function; or o Create a normal appearance to the extent possible; • Dental and orthodontic surgery services directly related to cleft palate repair; and • Surgery and surgically-implanted prosthetic devices in accordance with the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Benefits do not include: • Cosmetic surgery, which is surgery that is performed to alter or reshape normal structures of the body to improve appearance; • Reconstructive Surgery when there is a more appropriate procedure that will be approved; or • Reconstructive Surgery to create a normal appearance when it offers only a minimal improvement in appearance. In accordance with the WHCRA, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered for either breast to restore and achieve symmetry following a mastectomy, and for the treatment of the physical complications of a mastectomy, including lymphedemas. For coverage of prosthetic devices following a mastectomy, see the Durable medical equipment section. Medically Necessary services will be determined by your attending Physician in consultation with you. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons, except as required under the WHCRA.
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function, or (2) to create a normal appearance to the extent possible. Benefits include dental and orthodontic services that are an integral part of this surgery for cleft palate procedures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. In accordance with the Women’s Health & Cancer Rights Act, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered on either breast to restore and achieve symmetry incident to a mastectomy, and treatment of physical complications of a mastectomy, including lymphedemas. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons. Benefits are provided for outpatient Physical, Occupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records for Medical Necessity. Benefits for Speech Therapy are described in the See the Home Health Care Benefits and Hospice Program Benefits sections for information on coverage for Rehabilitation/Habilitation services rendered in the home. Benefits are provided for Skilled Nursing services in a Skilled Nursing unit of a Hospital or a free- standing Skilled Nursing Facility, up to the Benefit maximum as shown on the Summary of Benefits. The Benefit maximum is per Member per Benefit Period, except that room and board charges in excess of the facility’s established semi-private room rate are excluded. A “Benefit Period” begins on the date the Member is admitted into the facility for Skilled Nursing services, and ends 60 days after being discharged and Skilled Nursing services are no longer being received. A new Benefit Period can begin only after an existing Benefit Period ends. Benefits are provided for Medically Necessary outpatient Speech Therapy services when ordered by a Physician or other appropriately licensed or certified Health Care Provider pursuant to a written treatment plan to: correct or improve (1) a communication impairment; (...
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function, or (2) to create a normal appearance to the extent possible. Benefits include dental and orthodontic services that are an integral part of this surgery for cleft palate procedures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. In accordance with the Women’s Health & Cancer Rights Act, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered on either breast to restore and achieve symmetry incident to a mastectomy, and treatment of physical complications of a mastectomy, including lymphedemas. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons. Benefits are provided for outpatient Physical, Occupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records. Services provided by a chiropractor are not included in this Rehabilitation/Habilitation benefit. Benefits for Speech Therapy are described in the
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tu- mors, or disease to do either of the following to:
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital de- fects, developmental abnormalities, trauma, infec- tion, tumors, or disease to do either of the follow- ing: (1) to improve function, or (2) to create a nor- mal appearance to the extent possible. Benefits in- clude dental and orthodontic services that are an integral part of this surgery for cleft palate proce- dures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. In accordance with the Women’s Health & Cancer Rights Act, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered on either breast to restore and achieve symmetry inci- dent to a mastectomy, and treatment of physical complications of a mastectomy, including lym- phedemas. Benefits will be provided in accordance with guidelines established by Blue Shield and devel- oped in conjunction with plastic and reconstructive surgeons. Benefits are provided for outpatient Physical, Oc- cupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records for Medi- cal Necessity. Benefits for Speech Therapy are described in the
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Reconstructive Surgery Benefits. Reconstructive Surgery, performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease is covered when: 1. pre-authorization is requested by the Member’s PCP in consultation with the Member’s Specialist and approved by HMO, 2. the requested surgery will improve function or create a normal appearance to the extent possible, 3. there is no more appropriate surgical procedure which will be approved for the Member, 4. the proposed surgery or surgeries offer more than a minimal improvement in the appearance of the Pre-authorization decisions, including determining whether Reconstructive Surgery will produce more than a minimal improvement in the appearance of the Member, shall be made by HMO Medical Director or delegate who is a licensed Physician competent to evaluate the specific clinical issues involved in the care requested, based upon the standards of care practiced by Physicians specializing in the type of reconstructive surgery. This means, for example, that for a treatment request submitted by a podiatrist or an oral and maxillofacial surgeon, the request will be reviewed by a similarly licensed individual, competent to evaluate the specific clinical issues involved in the care requested.
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal Benefits for Speech Therapy are described in the Speech Therapy Benefits (Rehabilitation and Habil- itative Services) section. See the Home Health Care Benefits and Hospice Program Benefits sections for information on cov- erage for Rehabilitation services rendered in the home. structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tu- mors, or disease to do either of the following to:
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function, or (2) to create a normal appearance to the extent possible. Benefits include dental and orthodontic services that are an integral part of this surgery for cleft palate procedures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. Benefits are provided for outpatient Physical, Occupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records. Services provided by a chiropractor are not included in this Rehabilitation/Habilitation benefit. Benefits for Speech Therapy are described in the Speech Therapy Benefits section.
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Related to Reconstructive Surgery Benefits

  • Dental Benefits The County offers dental and orthodontic benefits to full and part-time regular employees and their eligible dependent(s). Benefit provisions, co­ payments and deductibles are outlined in the Evidence of Coverage. The employee contribution is $13 per pay period ($28.26 per month). The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Retiree Medical Benefits If Executive is or would become fifty-five (55) or older and Executive's age and service equal sixty-five (65) and Executive has at least five (5) years of service with the Company within two (2) years of Change in Control, Executive is eligible for retiree medical benefits (as such are determined immediately prior to Change in Control). Executive is eligible to commence receiving such retiree medical benefits based on the terms and conditions of the applicable plans in effect immediately prior to the Change in Control.

  • Membership Benefits (1) Seat on the Buy California Board (2) Licensed use of the CA Grown logo by all commodity entities (3) Commodity products featured in BCMA campaigns

  • Survivor Benefits 1. A surviving dependent of a retiree who was eligible to receive a Retiree Medical Grant, as stated above in A through C, and who qualifies for a monthly allowance shall be eligible for fifty (50) percent of the Grant authorized for the retiree. 2. A surviving eligible retiree who qualifies for a monthly retirement allowance who was married to a retiree who was also eligible for a Grant shall receive the survivor benefit described in D.1., above, or his or her own Grant, whichever is greater. Such retiree shall not be eligible for both Grants.

  • Project Employment A. Permanent project employees have layoff rights. Options will be determined using the procedure outlined in Sections 35.9 and 35.10, above. B. Permanent status employees who left regular classified positions to accept project employment without a break in service have layoff rights within the Employer in which they held permanent status to the job classification they held immediately prior to accepting project employment.

  • Plan Benefits Each year, prior to the annual enrollment period, EMPLOYEES will receive Enrollment information that will outline the benefits offered next calendar year. Information relative to specific health insurance benefits and limitations will be updated regularly and contained in the SPD. In the event there is a conflict between the provisions of the collective bargaining agreement and the SPD, the District's SPD shall control.

  • SUPPLEMENTAL BENEFITS The employer shall maintain a “Supplemental Unemployment Benefits Plan” pursuant to the Employment Insurance Act and Regulations in regard to maternity, parental and adoption leave. The employer shall make amendments as appropriate to ensure that the Plan provides the maximum permissible benefits in conjunction with Articles 17.06, 17.07 or 17.08.

  • Retirement, Welfare and Fringe Benefits During the Period of Employment, the Executive shall be entitled to participate in all employee pension and welfare benefit plans and programs, and fringe benefit plans and programs, made available by the Company to the Company’s employees generally, in accordance with the eligibility and participation provisions of such plans and as such plans or programs may be in effect from time to time.

  • Death Benefits Upon the Executive’s death during the Contract Period, the Executive’s estate shall not be entitled to any further benefits under this Agreement.

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