Surgical Covered Services Sample Clauses

Surgical Covered Services. Surgery Covered Services will be provided for services rendered by a Professional Provider and/or Facility Provider in a Physician's office or in a short procedure unit, Hospital, Outpatient department, or Freestanding Outpatient Facility for the treatment of disease or injury. Separate payment will not be made for Inpatient pre- operative care or all post-operative care normally provided by the surgeon as part of the surgical procedure. Except for bi-lateral knee replacements, for more than one surgical procedure performed at the same time and same operative site by the same surgeon, the sum of the Allowable Charges will be: − 100% for the primary procedure, and − 50% for all other procedures. For questions concerning Pre-Certification, the Participant should contact First Priority Life by calling a BlueCare Service Representative prior to the service being rendered. Ambulatory Surgery ( i.e., Surgery performed in an acute-care Hospital's short procedure unit or a free-standing surgical facility) requires Pre- Certification by First Priority Life for certain procedures, regardless of Provider. Outpatient Surgery (i.e., Surgery performed in a Physician's office or in an acute-care Hospital's Outpatient department) also requires Pre-Certification of certain procedures by First Priority Life regardless of Provider. • Upon Pre-Certification, Surgery Covered Services are covered for the surgical treatment of Morbid Obesity, provided the Participant is at least eighteen (18) years of age and has no prior history of bariatric Surgery. If the preferred Coinsurance on the Outline of Coverage indicates "none," a Copayment of $2,000 applies for the procedure when performed by a Preferred Provider or as indicated on the Outline of Coverage. Copayments are the responsibility of the Participant. • When a panniculectomy is Medically Necessary, upon Pre-Certification it is limited to one (1) procedure per lifetime or as indicated on the Outline of Coverage for those eighteen (18) years of age or older. If the preferred Coinsurance on the Outline of Coverage indicates "none," a Copayment of $1,000 applies for the procedure when performed by a Preferred Provide or as indicated on the Outline of Coverage. Copayments are the responsibility of the Participant. • Reconstructive Surgery will only be covered when required to restore function following accidental injury, infection, or disease in order to achieve reasonable physical or bodily function; in connection with congenita...
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Related to Surgical Covered Services

  • Covered Services Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.

  • Medical Coverage The Executive shall be entitled to such continuation of health care coverage as is required under, and in accordance with, applicable law or otherwise provided in accordance with the Company’s policies. The Executive shall be notified in writing of the Executive’s rights to continue such coverage after the termination of the Executive’s employment pursuant to this Section 3(d)(iv), provided that the Executive timely complies with the conditions to continue such coverage. The Executive understands and acknowledges that the Executive is responsible to make all payments required for any such continued health care coverage that the Executive may choose to receive.

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following:

  • Provision of Covered Services Contractor shall undertake commercially reasonable efforts to ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in this Agreement, as mutually agreed upon by Covered California and Contractor, and which may include the following:

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • Retiree Medical Coverage ‌ An eligible retiree and eligible dependent(s) (as defined below), may be enrolled in a County offered medical plan as described in section 10.2 but is allowed only to enroll either as a subscriber in a County offered medical plan or, as the dependent spouse/domestic partner of another eligible County employee/retiree, but not both. If an employee/retiree is also eligible to cover their dependent child/children, each child will be allowed to enroll as a dependent on only one employee or retirees’ plan (i.e., a retiree and his or her dependents cannot be covered by more than one County offered plan). An eligible dependent is (as defined in each plan document/summary plan description):  Xxxxxx the retiree’s spouse or domestic partner; or  A child, based on your plan’s age limits, or a disabled dependent child regardless of age.

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.

  • Product Coverage This Agreement shall apply to all manufactured products, - including capital goods, processed agricultural products, and those products failing outside the definition of agricultural products as set out in this Agreement. Agricultural products shall be excluded from the CEPT Scheme.

  • Inpatient In accordance with Rhode Island General Law §27-20-17.1, this agreement covers a minimum inpatient hospital stay of forty- eight (48) hours from the time of a vaginal delivery and ninety-six (96) hours from the time of a cesarean delivery: • If the delivery occurs in a hospital, the hospital length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple births, at the time of the last delivery). • If the delivery occurs outside a hospital, the hospital length of stay begins at the time the mother or newborn is admitted as a hospital in connection with childbirth. Any decision to shorten these stays shall be made by the attending physician in consultation with and upon agreement with you. In those instances where you and your infant participate in an early discharge, you will be eligible for: • up to two (2) home care visits by a skilled, specially trained registered nurse for you and/or your infant, (any additional visits must be reviewed for medical necessity); and • a pediatric office visit within twenty-four (24) hours after discharge. See Section 3.23 - Office Visits for coverage of home and office visits. We cover hospital services provided to you and your newborn child. Your newborn child is covered for services required to treat injury or sickness. This includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities as well as routine well-baby care.

  • Grandfathered Services Services identified in GTE Tariffs as grandfathered in any manner are available for resale only to end user customers that already have such grandfathered service. An existing end user customer may not move a grandfathered service to a new service location. Grandfathered services are subject to a resale discount.

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