Common use of Review of Certain Procedures Clause in Contracts

Review of Certain Procedures. Certain non-emergency surgical procedures are deemed to be elective surgery and may require a review by the Utilization Review Agent in order to be eligible for maximum benefits under this Plan. These procedures are subject to Prospective Procedure Review as described in Section V.A.2. BENEFIT PAYMENT  IN-NETWORK COVERAGE IN-NETWORK COINSURANCE FOR ELIGIBLE EXPENSES AFTER THE DEDUCTIBLE UP TO IN-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL IF PERFORMED IN A DOCTOR'S OFFICE, ONE HUNDRED PERCENT (100%) OF ELIGIBLE CHARGES AFTER A $30 COPAYMENT PER OFFICE VISIT WITH A GENERAL PRACTITIONER OF FAMILY PRACTICE, A PEDIATRICIAN OR AN INTERNIST AND A $40 COPAYMENT PER OFFICE VISIT WITH A SPECIALIST.  OUT-OF-NETWORK COVERAGE OUT-OF-NETWORK COINSURANCE OF ELIGIBLE EXPENSES AFTER THE OUT-OF-NETWORK DEDUCTIBLE UP TO OUT-OF-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL

Review of Certain Procedures. Certain non-emergency surgical procedures are deemed to be elective surgery and may require a review by the Utilization Review Agent in order to be eligible for maximum benefits under this Plan. These procedures are subject to Prospective Procedure Review as described in Section V.A.2. BENEFIT PAYMENT  IN-NETWORK COVERAGE IN-NETWORK COINSURANCE FOR ELIGIBLE EXPENSES AFTER THE DEDUCTIBLE UP TO IN-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL IF PERFORMED IN A DOCTOR'S OFFICE, ONE HUNDRED PERCENT (100%) OF ELIGIBLE CHARGES AFTER A $30 COPAYMENT PER OFFICE VISIT WITH A GENERAL PRACTITIONER OF FAMILY PRACTICE, A PEDIATRICIAN OR AN INTERNIST AND A $40 COPAYMENT PER OFFICE VISIT WITH A SPECIALIST.  OUT-OF-NETWORK COVERAGE OUT-OF-NETWORK COINSURANCE OF ELIGIBLE EXPENSES AFTER THE OUT-OF-OF- NETWORK DEDUCTIBLE UP TO OUT-OF-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL

Review of Certain Procedures. Certain non-emergency surgical procedures are deemed to be elective surgery and may require a review by the Utilization Review Agent in order to be eligible for maximum benefits under this Plan. These procedures are subject to Prospective Procedure Review as described in Section V.A.2. BENEFIT PAYMENT  ◼ IN-NETWORK COVERAGE IN-NETWORK COINSURANCE FOR ELIGIBLE EXPENSES AFTER THE DEDUCTIBLE UP TO IN-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL IF PERFORMED IN A DOCTOR'S OFFICE, ONE HUNDRED PERCENT (100%) OF ELIGIBLE CHARGES AFTER A $30 COPAYMENT PER OFFICE VISIT WITH A GENERAL PRACTITIONER OF FAMILY PRACTICE, A PEDIATRICIAN OR AN INTERNIST AND A $40 COPAYMENT PER OFFICE VISIT WITH A SPECIALIST.  ◼ OUT-OF-NETWORK COVERAGE OUT-OF-NETWORK COINSURANCE OF ELIGIBLE EXPENSES AFTER THE OUT-OF-NETWORK DEDUCTIBLE UP TO OUT-OF-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL

Review of Certain Procedures. Certain non-emergency surgical procedures are deemed to be elective surgery and may require a review by the Utilization Review Agent in order to be eligible for maximum benefits under this Plan. These procedures are subject to Prospective Procedure Review as described in Section V.A.2. BENEFIT PAYMENT  IN-NETWORK COVERAGE IN-NETWORK COINSURANCE FOR ELIGIBLE EXPENSES AFTER THE DEDUCTIBLE UP TO IN-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL IF PERFORMED IN A DOCTOR'S OFFICE, ONE HUNDRED PERCENT (100%) OF ELIGIBLE CHARGES AFTER A $30 25 COPAYMENT PER OFFICE VISIT WITH A GENERAL PRACTITIONER OF FAMILY PRACTICE, A PEDIATRICIAN OR AN INTERNIST AND A $40 30 COPAYMENT PER OFFICE VISIT WITH A SPECIALIST.  OUT-OF-NETWORK COVERAGE OUT-OF-NETWORK COINSURANCE OF ELIGIBLE EXPENSES AFTER THE OUT-OF-NETWORK DEDUCTIBLE UP TO OUT-OF-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL

Review of Certain Procedures. Certain non-emergency surgical procedures are deemed to be elective surgery and may require a review by the Utilization Review Agent in order to be eligible for maximum benefits under this Plan. These procedures are subject to Prospective Procedure Review as described in Section V.A.2. BENEFIT PAYMENT  IN-NETWORK COVERAGE IN-NETWORK COINSURANCE FOR ELIGIBLE EXPENSES AFTER THE DEDUCTIBLE UP TO IN-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL IF PERFORMED IN A DOCTOR'S OFFICE, ONE HUNDRED PERCENT (100%) OF ELIGIBLE CHARGES AFTER A $30 COPAYMENT PER OFFICE VISIT WITH A GENERAL PRACTITIONER OF FAMILY PRACTICE, A PEDIATRICIAN OR AN INTERNIST AND A $40 COPAYMENT PER OFFICE VISIT WITH A SPECIALIST.   OUT-OF-NETWORK COVERAGE OUT-OF-NETWORK COINSURANCE OF ELIGIBLE EXPENSES AFTER THE OUT-OF-OF- NETWORK DEDUCTIBLE UP TO OUT-OF-NETWORK STOP-LOSS AND THEN ELIGIBLE EXPENSES COVERED IN FULL