Skilled Nursing Care Sample Clauses

Skilled Nursing Care. All Skilled Nursing Care services, except home infusion and related services, require Prior Authorization by the Company in order to be eligible for benefits. If prior approval is not obtained, the Company has the right to request medical records to review to determine whether services are eligible under this Contract. a. Covered services that require that the patient be homebound: An Insured will be considered to be homebound if they have a condition due to illness or injury for which leaving the home is medically contraindicated. The Company has the right to determine whether the patient is homebound. (1) Skilled Nursing Care visits include services provided by a Medicare certified Home Health Agency. (2) Skilled Nursing Care services are covered when provided by a state licensed nursing agency or state licensed nurse on an hourly basis. b. Covered services that do not require that the patient be homebound: (1) Home care education associated with diabetes, colostomy care, wound care, IV therapy or any other condition or treatment which the Company has determined is appropriate for home care education, when provided by a Medicare certified Home Health Agency. Benefits for educational services will be limited to no more than three home care education visits per Benefit Period for which home care education is appropriate. (2) Home infusion and related services. These services can be provided by either a Medicare certified Home Health Agency, state licensed nursing agency or state licensed nurse. c. Skilled Nursing Care services do not include: (1) Services provided by a member of the Insured's immediate family. (2) Services provided by a person who normally lives in the Insured's home. (3) Custodial/Maintenance Care. The Company has the right to determine which services are Custodial/Maintenance Care.
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Skilled Nursing Care. Skilled supervision and management of a complicated or extensive plan of care for a CDCR/CCHCS patient and/or DJJ youth initiated and monitored by a physician in which there is a significantly high probability that complications would arise without the skilled supervision or implementation of the treatment program by a licensed nurse or therapist.
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Skilled Nursing Care. When determined appropriate pursuant to the Medical Care Contract, you may receive 24-hour nursing care at Villa Marin's Nursing Facility on a priority access basis over nonresidents. As part of the admissions process, you agree to sign a separate Skilled Nursing Facility Admission Agreement in its then current form. The current version of this document is attached as Appendix D. The services you receive and certain additional rights and obligations will be set forth in the Skilled Nursing Facility Admission Agreement. The terms of this Agreement shall continue to apply, and in the event of a conflict between the terms of the two agreements, this Agreement shall govern.
Sample 1
Skilled Nursing Care. Riverview shall provide ten (10) days of skilled nursing care, hereafter referred to as “Skilled Nursing Care,” per year for you in Riverview Care Center when such care is prescribed by your physician and if the Care Center can meet your needs. If space is not immediately available at Riverview Care Center, you shall be admitted to Riverview Care Center as soon as possible in accordance with the admission policies of Riverview Care Center. If space at the Care Center is not available, Riverview will provide the benefits described in this Section 3.2 at a comparable facility in the Spokane area at a daily rate which is not more than the median care rate charged by Riverview Care Center. Riverview will assist you in locating an alternate health care facility. You shall be responsible for payment of all transportation costs to and from Riverview and the alternate health care facility. Prior to utilizing the ten (10) days of Skilled Nursing Care offered by Riverview, you shall first use your U.S. Government or State medical benefits, if applicable. The Skilled Nursing Care in Riverview Care Center provided in this Agreement is secondary to such coverage. You are responsible for the payment of all doctor, special nursing care, dental, drugs, ancillary services, hospital care, and other care you may require during the term of this Agreement. The ten (10) days of Skilled Nursing Care are limited to each twelve (12) month period, commencing upon the Occupancy Date. The Skilled Nursing Care is not cumulative from one twelve (12) month period to the next. Any fraction of a day of such Skilled Nursing Care shall be considered one (1) day. The right to Skilled Nursing Care is not transferable or assignable by you. The Skilled Nursing Care has no cash value, and you are not entitled to any payment for Skilled Nursing Care not used during any twelve
Sample 1
Skilled Nursing Care. Skilled Nursing Care is defined as care within the limitations to the equipment and staff of a Skilled Nursing Facility and includes services and items such as nursing care; room and board (including semi-private rooms); medical social services; medical supplies; and durable medical equipment ordinarily furnished by a Skilled Nursing Facility; and external prosthetic devices and braces ordinarily furnished by a Skilled Nursing Facility. Medicare guidelines are used to determine when care in a Skilled Nursing Facility is covered, except that a prior three day stay in an acute care hospital is not required. Up to 120 days of prescribed Skilled Nursing Care per Accumulation Period are provided or arranged at approved facilities (including Hospitals or Skilled Nursing Facilities) without charge. kpgroup_snf_0d_120accum_16.doc 01/2016 The Group Medical and Hospital Service Agreement is amended by deleting sections S-1(a) and S-1(b) (Emergency Department Services) of the benefit schedule and substituting a new sections S-1(a) and S-1(b) as follows:
Sample 1

Related to Skilled Nursing Care

  • Skilled Care in a Nursing Facility This plan covers skilled nursing services in a skilled nursing facility if: • the services are prescribed by a physician: • your condition needs skilled nursing services, skilled rehabilitation services or skilled nursing observation; • the services are provided by or supervised by licensed technical or professional medical personnel; and • the services are not custodial care, respite care, day care, or for the purpose of assisting with activities of daily living.

  • Urgent Care This plan covers services received at an urgent care center. For other services, such as surgery or diagnostic tests, the amount that you pay is based on the type of service being provided. See Summary of Medical Benefits for details. Follow-up care (such as suture removal or wound care) should be obtained from your

  • Child Care The County will continue to support the concept of non-profit child care facilities similar to the “Kid’s at Work” program established in the Public Works Department.

  • Family Care Employees may use vacation leave for care of family members as required by the Family Care Act, WAC 296-130.

  • Dental Care a. Dental Care for Members over age 19 is limited to the following: i. care and stabilization treatment rendered within 62 days of an Accidental Dental Injury provided such services are for the treatment of damage to Sound Natural Teeth; ii. extraction of teeth required prior to radiation therapy when you have a diagnosis of cancer of the head or neck. b. General anesthesia and hospitalization services are covered when required to assure the safe delivery of necessary dental treatment or surgery for a dental Condition which, if left untreated, is likely to result in a medical Condition if: i. a Member has one or more medical Conditions that would create significant or undue medical risk for the Member in the course of delivery of any necessary dental treatment or surgery if not rendered in a Hospital or Ambulatory Surgery Center; or ii. a Covered Dependent child is under eight years of age and it is determined by a licensed dentist and the Covered Dependent’s Attending Physician that dental treatment or surgery in a Hospital or Ambulatory Surgery Center is necessary due to a significantly complex dental Condition, or a developmental disability in which patient management in the dental office has proven to be ineffective.

  • Hospice Care If you have a terminal illness and you agree with your physician not to continue with a curative treatment program, this plan covers hospice care services received in your home, in a skilled nursing facility, or in an inpatient facility.

  • Long Term Care The City may offer an option for employees to purchase a new long-term care benefit for themselves and certain family members.

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

  • Vision Care For the duration of this Agreement, the University will continue to provide a vision care plan for members of the bargaining unit and their dependents with benefit levels not less than those in effect as in the predecessor Agreement.

  • Medical Care The Parents must comply with the School Welfare Officer's recommendations which may include a reasonable decision to release the Pupil home or to his / her education guardian when s/he is unwell.

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