Services Not Covered. This service contract does not cover service, maintenance, repair, or replacement necessitated by any loss or damage occurring prior to the issuance of this service contract and resulting from (1) any cause other than normal usage, such as, but not limited to loss or damage due to misuse, abuse, neglect; (2) unauthorized repair by others; (3) lack of manufacturer’s recommended maintenance; (4) any commercial use or use other than that of a personal, domestic, or household nature unless otherwise selected on Schedule Page; (5) inherent design defect in the product; (6) rust, corrosion, insect infestation, fire, water, windstorm, hail, earthquake, theft or burglary, negligence, vandalism, transport, riot, environmental conditions, sand, dirt, damage from exposure to weather conditions, any intentional acts caused by You, power reductions or fluctuations, lightning, flood, malicious mischief, civil commotion, arson or explosion. IN NO EVENT SHALL THIS SERVICE CONTRACT BE LIABLE FOR SPECIAL, INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES WHETHER
Services Not Covered. This service contract does not cover service, maintenance, repair, or replacement necessitated by any loss or damage occurring prior to the issuance of this service contract and resulting from (1) any cause other than normal usage, such as, but not limited to loss or damage due to misuse, neglect; (2) unauthorized repair by others; (3) lack of manufacturer’s recommended maintenance; (4) any commercial use; (5) inherent design defect in the product; (6) rust, corrosion, insect infestation, fire, water, windstorm, hail, earthquake, theft or burglary, negligence, vandalism, transport, riot, environmental conditions, sand, dirt, damage from exposure to weather conditions, any intentional acts caused by You, power reductions or fluctuations, lightning, flood, malicious mischief, civil commotion, arson or explosion. IN NO EVENT SHALL THIS SERVICE CONTRACT BE LIABLE FOR SPECIAL, INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES WHETHER IN
Services Not Covered. The Parties recognize that the Contractor may provide services to Sellers beyond those covered in Sections B.1 and B.2 of this Contract. These may include, but are not limited to:
(a) General accounting services;,
(b) Invoice preparation, billing and accounts receivable collection services;,
(c) Tax calculation or reporting services unrelated to the CSP Services; and,
(d) Consulting services. Such services are not within the Scope of Services provided in Sections B.1 and B.2 of this Contract and neither the Governing Board nor any Streamlined State certifies, approves, or recommends the Contractor as a provider of such services and the Contractor may not represent or imply that the system is certified, approved or endorsed for such use by the Governing Board.
Services Not Covered a. Behavioral Health Services Contractors will not be responsible for coverage of behavioral health services. Behavioral health services are defined as any inpatient or residential treatment for mental disorders; any outpatient hospital mental health treatment (revenue codes 90X and 91X or procedure codes 908XX); any procedure using procedure code 908XX; other mental health services using HCPCS codes for programs described in Medicaid Policy Sections 15 or 21; and any service outlined in the approved waivers for IDDD or SED (MYPAC). The Contractor will be responsible for coverage of all drugs, including psychotropic drugs, for Members as many of these medicines are prescribed by primary care physicians.
b. Non-emergency Transportation Services Contractors will not be responsible for coverage of non-emergency transportation services. The Division has an existing contract with a provider for these services. However, the Contractor will be required to coordinate with the non-emergency transportation provider for provision of these services to Members.
c. Inpatient Hospital Services Contractors will not be responsible for coverage of inpatient hospital services. However, the Contractor will be responsible for coverage of services billed by physicians and other providers during a hospital stay (including, but not limited to, physician surgeries, inpatient physician visits, etc).
Services Not Covered. Dental care benefits are not payable for prescription drugs, hospital charges except for those items listed as eligible expenses, charges of an anesthetist or anesthesiologist while the insured is hospitalized, those services provided for under the Alberta Health Insurance Act or other government legislation, services eligible for payment from another source such as Workers' Compensation, a government agency or any other insurer, expenses incurred principally for cosmetic purposes, expenses resulting from an act of war, or any service for which an employee or dependent does not have to pay.
Services Not Covered. Services purely cosmetic in nature, or for purely cosmetic reasons. • Charges for broken appointments. • Services covered or provided through Workers’ Compensation legislation, any government agency, or a third party liability. • Congenital malformations, e.g. cleft palate prosthesis (if included in this Proposal). • Major dental services including inlays, crowns, bridges, full dentures, partial dentures, including facings on crowns or pontics (false teeth) more often than once every five (5) years. • Fees arising out of extra services arranged for privately between the patient and the dentist. • Implants. • Oral hygiene instruction. • Plaque control programs. • Charges for completing claim forms.
Services Not Covered. An employee or dependent shall not be eligible for and no amount will be payable for any procedures resulting from any of the following: Resulting from illness or injury for which the employee or dependent is entitled to benefit under the Compensation Act or similar law, or Which was not recommended and approved by a physician
Services Not Covered. The plan does not cover the following services: ➢ services that are not routinely performed by a dentist or denturist;. ➢ services that are not reasonable or necessary to maintain or restore teeth; ➢ services for which any benefits are payable under Workers' Compensation or any publicly supported plans; ➢ services not included in the dental or denturist fee schedules; ➢ services required because of war, riot, or self-inflicted injury, while sane or insane; ➢ services required because of participation in, attempt or commission of a criminal act; ➢ temporary dentistry, oral hygiene instruction, tissue grafts, services purely cosmetic in nature or used to correct congenital malformations; ➢ drug or medicines; ➢ services related to the functioning or structure of the jaw, jaw muscles or temporo mandibular joint; ➢ implants; ➢ replacement of lost or stolen orthodontia appliances; ➢ charges for appointments not kept; ➢ charges resulting from a change of dentist or denturist, unless approved by the plan carrier; ➢ charges for completing forms; ➢ charges for work in progress at the time the coverage for you and your dependents is terminated.
Services Not Covered. Congenital malformations.
Services Not Covered. Except as authorized pursuant to Section 2.6.5 of this Agreement, the CONTRACTOR shall not pay for non-covered services as described in TennCare rules and regulations.
