Transplant Services. Subject to the provisions of this Agreement, benefits will be provided for Covered Services furnished by a Hospital which are directly and specifically related to transplantation of organs, bones, tissue or blood stem cells. If a human organ, bone, tissue or blood stem cell transplant is provided from a living donor to a human transplant recipient: 1. When both the recipient and the donor are Members, each is entitled to the benefits of this Agreement; 2. When only the recipient is a Member, both the donor and the recipient are entitled to the benefits of this Agreement subject to the following additional limitations: a. The 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 other Blue Cross or Blue Shield coverage or any government program, and b. Benefits provided to the donor will be charged against the recipient’s coverage under this Agreement to the extent that benefits remain and are available under this Agreement after benefits for the recipient’s own expenses have been paid; 3. When only the donor is a Member, the donor is entitled to the benefits of this Agreement, subject to the 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, tissue or blood stem cell is sold rather than donated to the Member recipient, no benefits will be payable for the purchase price of such organ, tissue or blood stem cell; however, other costs related to evaluation and procurement are covered up to the Member recipient’s Agreement limit. Y. VISION CARE SERVICES Benefits are provided for Members every twelve (12) consecutive months for the following when rendered by a Vision Provider who is a Network Provider: a. one (1) comprehensive eye examination (including dilation as professionally indicated); b. one (1) pair of single vision, bifocal, trifocal or lenticular lenses (including glass, plastic or oversized lenses); and c. one (1) pair of frames from a selection designated by the Plan. Coverage for Pediatric Vision Care Services terminates at the end of the month in which the Member reaches age nineteen (19). Benefits provided under this Subsection are not subject to the provisions of Subsection F. COORDINATION OF BENEFITS of SECTION GP - GENERAL PROVISIONS of this Agreement.
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Samples: Individual Comprehensive Major Medical Exclusive Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement, Individual Comprehensive Major Medical Exclusive Provider Subscription Agreement
Transplant Services. Subject to the provisions of this Agreement, benefits will be provided for Covered Services furnished by a Hospital which are directly and specifically related to transplantation of organs, bones, tissue or blood stem cells. If a human organ, bone, tissue or blood stem cell transplant is provided from a living donor to a human transplant recipient:
1. When both the recipient and the donor are Members, each is entitled to the benefits of this Agreement;
2. When only the recipient is a Member, both the donor and the recipient are entitled to the benefits of this Agreement subject to the following additional limitations:
a. The 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 other Blue Cross or Blue Shield coverage or any government program, and
b. Benefits provided to the donor will be charged against the recipient’s coverage under this Agreement to the extent that benefits remain and are available under this Agreement after benefits for the recipient’s own expenses have been paid;
3. When only the donor is a Member, the donor is entitled to the benefits of this Agreement, subject to the 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, tissue or blood stem cell is sold rather than donated to the Member recipient, no benefits will be payable for the purchase price of such organ, tissue or blood stem cell; however, other costs related to evaluation and procurement are covered up to the Member recipient’s Agreement limit. Y. VISION CARE SERVICES Benefits are provided for Members every twelve (12) consecutive months for the following when rendered by a Vision Provider who is a Network Provider:
a. 1. one (1) comprehensive eye examination (including dilation as professionally indicated);
b. 2. one (1) pair of single vision, bifocal, trifocal or lenticular lenses (including glass, plastic or oversized lenses); and
c. 3. one (1) pair of frames from a selection designated by the Plan. Coverage for Pediatric Vision Care Services terminates at the end of the month in which the Member reaches age nineteen (19). Benefits provided under this Subsection are not subject to the provisions of Subsection F. COORDINATION OF BENEFITS of SECTION GP - GENERAL PROVISIONS of this Agreement.
Appears in 2 contracts
Samples: Individual Comprehensive Major Medical Preferred Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement
Transplant Services. Subject to the provisions of this Agreement, benefits will be provided for Covered Services furnished by a Hospital which are directly and specifically related to transplantation of organs, bones, tissue or blood stem cells. If a human organ, bone, tissue or blood stem cell transplant is provided from a living donor to a human transplant recipient:
1. When both the recipient and the donor are Members, each is entitled to the benefits of this Agreement;
2. When only the recipient is a Member, both the donor and the recipient are entitled to the benefits of this Agreement subject to the following additional limitations:
a. The 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 other Blue Cross or Blue Shield coverage or any government program, and
b. Benefits provided to the donor will be charged against the recipient’s coverage under this Agreement to the extent that benefits remain and are available under this Agreement after benefits for the recipient’s own expenses have been paid;
3. When only the donor is a Member, the donor is entitled to the benefits of this Agreement, subject to the 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, tissue or blood stem cell is sold rather than donated to the Member recipient, no benefits will be payable for the purchase price of such organ, tissue or blood stem cell; however, other costs related to evaluation and procurement are covered up to the Member recipient’s Agreement limit. Y. VISION CARE SERVICES Benefits are provided for Members every twelve (12) consecutive months for the following when rendered by a Vision Provider who is a Network Provider:
a. one (1) comprehensive eye examination (including dilation as professionally indicated);
b. one (1) pair of single vision, bifocal, trifocal or lenticular lenses (including glass, plastic or oversized lenses); and
c. one (1) pair of frames from a selection designated by the Plan. Coverage for Pediatric Vision Care Services terminates at the end of the month in which the Member reaches age nineteen (19). Benefits provided under this Subsection are not subject to the provisions of Subsection F. COORDINATION OF BENEFITS of SECTION GP - GENERAL PROVISIONS of this Agreement.
Appears in 1 contract
Transplant Services. Subject to the provisions of this Agreement, benefits will be provided for Covered Services furnished by a Hospital which are directly and specifically related to transplantation of organs, bones, tissue or blood stem cells. If a human organ, bone, tissue or blood stem cell transplant is provided from a living donor to a human transplant recipient:
1. When both the recipient and the donor are Members, each is entitled to the benefits of this Agreement;
2. When only the recipient is a Member, both the donor and the recipient are entitled to the benefits of this Agreement subject to the following additional limitations:
a. The 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 other Blue Cross or Blue Shield coverage or any government program, and
b. Benefits provided to the donor will be charged against the recipient’s coverage under this Agreement to the extent that benefits remain and are available under this Agreement after benefits for the recipient’s own expenses have been paid;
3. When only the donor is a Member, the donor is entitled to the benefits of this Agreement, subject to the 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, tissue or blood stem cell is sold rather than donated to the Member recipient, no benefits will be payable for the purchase price of such organ, tissue or blood stem cell; however, other costs related to evaluation and procurement are covered up to the Member recipient’s Agreement limit. Y. VISION CARE SERVICES Benefits are provided for Members every twelve (12) consecutive months for the following when rendered by a SERVICES
1. Pediatric Vision Provider who is a Network Provider:Care Services
a. one (1) comprehensive eye examination (including dilation as professionally indicated);
b. one (1) pair of single vision, bifocal, trifocal or lenticular lenses (including glass, plastic or oversized lenses); and
c. one (1) pair of frames from a selection designated by the Plan. Coverage for Pediatric Vision Care Services terminates at the end of the month in which the Member reaches age nineteen (19). Benefits provided under this Subsection are not subject to the provisions of Subsection F. COORDINATION OF BENEFITS of SECTION GP - GENERAL PROVISIONS of this Agreement.
Appears in 1 contract
Samples: Individual Comprehensive Major Medical Preferred Provider Subscription Agreement
Transplant Services. Subject to the provisions of this Agreement, benefits will be provided for Covered Services furnished by a Hospital which are directly and specifically related to transplantation of organs, bones, tissue or blood stem cells. If a human organ, bone, tissue or blood stem cell transplant is provided from a living donor to a human transplant recipient:
1. When both the recipient and the donor are Members, each is entitled to the benefits of this Agreement;
2. When only the recipient is a Member, both the donor and the recipient are entitled to the benefits of this Agreement subject to the following additional limitations:
a. The 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 other Blue Cross or Blue Shield coverage or any government program, and
b. Benefits provided to the donor will be charged against the recipient’s coverage under this Agreement to the extent that benefits remain and are available under this Agreement after benefits for the recipient’s own expenses have been paid;
3. When only the donor is a Member, the donor is entitled to the benefits of this Agreement, subject to the 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, tissue or blood stem cell is sold rather than donated to the Member recipient, no benefits will be payable for the purchase price of such organ, tissue or blood stem cell; however, other costs related to evaluation and procurement are covered up to the Member recipient’s Agreement limit. Y. VISION CARE SERVICES Benefits are provided for Members every twelve (12) consecutive months for the following when rendered by a Vision Provider who is a Network Provider:
a. 1. one (1) comprehensive eye examination (including dilation as professionally indicated);
b. 2. one (1) pair of single vision, bifocal, trifocal or lenticular lenses (including glass, plastic or oversized lenses); and
c. 3. one (1) pair of frames from a selection designated by the Plan. Coverage for Pediatric Vision Care Services terminates at the end of the month in which the Member reaches age nineteen (19). Benefits provided under this Subsection are not subject to the provisions of Subsection F. COORDINATION OF BENEFITS of SECTION GP - GENERAL PROVISIONS of this Agreement.
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