Common use of Transplant Services Clause in Contracts

Transplant Services. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. When the Member is the recipient of transplanted human organs, marrow, or tissues, benefits are provided for all Covered Services. Covered Services for Inpatient and Outpatient Care related to the transplant include procedures which are generally accepted as not Experimental/Investigational Services by medical organizations of national reputation. These organizations are recognized by the HMO as having special expertise in the area of medical practice involving transplant procedures. Benefits are also provided for those services which are directly and specifically related to the Member’s covered transplant. This includes services for the examination of such transplanted organs, marrow, or tissue and the processing of blood provided to the Member. The determination of Medical Necessity for transplants will take into account the proposed procedure's suitability for the potential recipient and the availability of an appropriate facility for performing the procedure. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. If a human organ or tissue transplant is provided from a donor to a human transplant recipient: 1. When both the recipient and the donor are Members, each is entitled to the benefits of this plan. 2. When only the recipient is a Member, both the donor and the recipient are entitled to the Benefits of this Agreement. However, donor Benefits are limited to only those not provided or available to the donor from any other source. This includes, but is not limited to, other insurance coverage or any government program. 3. When only the donor is a Member, the donor is entitled to the Benefits of this Agreement, subject to following additional limitations: a. The Benefits are limited to only those not provided or available to the donor from any other source in accordance with the terms of this Agreement; and b. No Benefits will be provided to the non-Member transplant recipient. 4. If any organ or tissue is sold rather than donated to the Member recipient, no Benefits will be payable for the purchase price of such organ or tissue; however, other costs related to evaluation and procurement are covered. Benefits for a covered transplant procedure shall include coverage for the medical expenses of a live donor to the extent that those medical expenses are not covered by another program. Covered Services of a donor include:  Removal of the organ;  Preparatory pathologic and medical examinations; and  Post-surgical care. Blue Distinction Centers for Transplant are a cooperative effort of the BlueCross and/or BlueShield Plans, the BlueCross BlueShield Association and participating medical institutions to provide patients who need transplants with access to leading transplant centers through a coordinated, streamlined program of transplant management. When a transplant is performed at a BDCT facility designated for that transplant type, certain Benefits are provided for travel, lodging, and meal expenses for the Member and one support companion, subject to the limitations set forth in Section A of this Medical Care Schedule of Benefits. Items that are not covered expenses include, but are not limited to, alcohol, tobacco, car rental, entertainment, expenses for persons other than the Member and the Member’s companion, phone calls, and personal care items.

Transplant Services. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. When the Member is the recipient of transplanted human organs, marrow, or tissues, benefits are provided for all Covered Services. Covered Services for Inpatient and Outpatient Care related to the transplant include procedures which are generally accepted as not Experimental/Investigational Services by medical organizations of national reputation. These organizations are recognized by the HMO as having special expertise in the area of medical practice involving transplant procedures. Benefits are also provided for those services which are directly and specifically related to the Member’s covered transplant. This includes services for the examination of such transplanted organs, marrow, or tissue and the processing of blood provided to the Member. The determination of Medical Necessity for transplants will take into account the proposed procedure's suitability for the potential recipient and the availability of an appropriate facility for performing the procedure. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. If a human organ or tissue transplant is provided from a donor to a human transplant recipient: 1. When both the recipient and the donor are Members, each is entitled to the benefits of this plan. 2. When only the recipient is a Member, both the donor and the recipient are entitled to the Benefits of this Agreement. However, donor Benefits are limited to only those not provided or available to the donor from any other source. This includes, but is not limited to, other insurance coverage or any government program. 3. When only the donor is a Member, the donor is entitled to the Benefits of this Agreement, subject to following additional limitations: a. The Benefits are limited to only those not provided or available to the donor from any other source in accordance with the terms of this Agreement; and b. No Benefits will be provided to the non-Member transplant recipient. 4. If any organ or tissue is sold rather than donated to the Member recipient, no Benefits will be payable for the purchase price of such organ or tissue; however, other costs related to evaluation and procurement are covered. Benefits for a covered transplant procedure shall include coverage for the medical expenses of a live donor to the extent that those medical expenses are not covered by another program. Covered Services of a donor include:  • Removal of the organ;  • Preparatory pathologic and medical examinations; and  • Post-surgical care. Blue Distinction Centers for Transplant are a cooperative effort of the BlueCross Blue Cross and/or BlueShield Blue Shield Plans, the BlueCross BlueShield Association and participating medical institutions to provide patients who need transplants with access to leading transplant centers through a coordinated, streamlined program of transplant management. When a transplant is performed at a BDCT facility designated for that transplant type, certain Benefits are provided for travel, lodging, and meal expenses for the Member and one support companion, subject to the limitations set forth in Section A of this Medical Care Schedule of Benefits. Items that are not covered expenses include, but are not limited to, alcohol, tobacco, car rental, entertainment, expenses for persons other than the Member and the Member’s companion, phone calls, and personal care items.