Common use of Transplants Clause in Contracts

Transplants. This benefit has one or more exclusions as specified in the Exclusions Section. All Organ transplants must be performed at an approved center and require Prior Authorization. Human Solid Organ transplant benefits are Covered for: • Kidney • Liver • Pancreas • Intestine • Heart • Lung • multi-visceral (3 or more abdominal Organs) • simultaneous multi-Organ transplants – unless investigational • pancreas islet cell infusion • Meniscal Allograft • Autologous Chondrocyte Implantation – knee only • Bone Marrow Transplant including peripheral blood bone marrow stem cell harvesting and transplantation (stem cell transplant) following high dose chemotherapy. Bone marrow transplants are Covered for the following indications: o multiple myeloma o leukemia o aplastic anemia o lymphoma o severe combined immunodeficiency disease (SCID) o Wiskott Xxxxxxx syndrome x Xxxxx’x Sarcoma o germ cell tumor o neuroblastoma o Wilms Tumor o myelodysplastic Syndrome o myelofibrosis o sickle cell disease o thalassemia major If there is a living donor that requires surgery to make an Organ available for a Covered transplant for our Member, Coverage is available for expenses incurred by the living donor for surgery, laboratory and X-ray services, Organ storage expenses, and Inpatient follow-up care only. We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy. $150 per day for the transplant recipient, live donor and one other person combined. Benefits will only be Covered for transportation, lodging and meals and are limited to a lifetime maximum of $10,000. All Organ transplants must be performed at site that we approve and require Prior Authorization.

Transplants. This benefit has one or more exclusions as specified in the Exclusions Section. All Organ transplants must be performed at an approved center and require Prior Authorization. Human Solid Organ transplant benefits are Covered for: • Kidney • Liver • Pancreas • Intestine • Heart • Lung • multi-visceral (3 or more abdominal Organs) • simultaneous multi-Organ transplants – unless investigational • pancreas islet cell infusion • Meniscal Allograft • Autologous Chondrocyte Implantation – knee only • Bone Marrow Transplant including peripheral blood bone marrow stem cell harvesting and transplantation (stem cell transplant) following high dose chemotherapy. Bone marrow transplants are Covered for the following indications: o multiple myeloma o leukemia o aplastic anemia o lymphoma o severe combined immunodeficiency disease (SCID) o Wiskott Xxxxxxx syndrome x Xxxxx’x Sarcoma o germ cell tumor o neuroblastoma o Wilms Tumor o myelodysplastic Syndrome o myelofibrosis o sickle cell disease o thalassemia major If there is a living donor that requires surgery to make an Organ available for a Covered transplant for our Member, Coverage is available for expenses incurred by the living donor for surgery, laboratory and X-ray services, Organ storage expenses, and Inpatient follow-up care only. We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy. $150 per day for the transplant recipient, live donor and one other person combined. Benefits will only be Covered for transportation, lodging and meals and are limited to a lifetime maximum of $10,000. All Organ transplants must be performed at site that we approve Wireless capsule endoscopy is a noninvasive procedure in which a capsule containing a miniature video camera is swallowed. Capsule endoscopy is used as an adjunctive therapy in patients who have had an esophagogastroduodenoscopy (EGD) or colonoscopy, and require these tests have failed to reveal evidence of disease or a source of bleeding. This procedure requires Prior Authorization.

Transplants. This benefit has one or more exclusions as specified in the Exclusions Section. All Organ transplants must be performed at an approved center and require Prior Authorization. Human Solid Organ transplant benefits are Covered for: • Kidney • Liver • Pancreas • Intestine • Heart • Lung • multi-visceral (3 or more abdominal Organs) • simultaneous multi-Organ transplants – unless investigational • pancreas islet cell infusion • Meniscal Allograft • Autologous Chondrocyte Implantation – knee only • Bone Marrow Transplant including peripheral blood bone marrow stem cell harvesting and transplantation (stem cell transplant) following high dose chemotherapy. Bone marrow transplants are Covered for the following indications: o multiple myeloma o leukemia o aplastic anemia o lymphoma o severe combined immunodeficiency disease (SCID) o Wiskott Xxxxxxx syndrome x Xxxxx’x Sarcoma o germ cell tumor o neuroblastoma o Wilms Tumor o myelodysplastic Syndrome o myelofibrosis o sickle cell disease o thalassemia major If there is a living donor that requires surgery to make an Organ available for a Covered transplant for our Member, Coverage is available for expenses incurred by the living donor for surgery, laboratory and X-ray services, Organ storage expenses, and Inpatient follow-up care only. We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy. $150 per day for the transplant recipient, live donor and one other person combined. Benefits will only be Covered for transportation, lodging and meals and are limited to a lifetime maximum of $10,000. All Organ transplants must be performed at site that we approve and require Prior Authorization.

Transplants. This benefit has one or more exclusions as specified in the Exclusions Section. All Organ transplants must be performed at an approved center and require Prior Authorization. Human Solid Organ transplant benefits are Covered for: • Kidney • Liver • Pancreas • Intestine • Heart • Lung • multiMulti-visceral (3 three or more abdominal Organs) • simultaneous Simultaneous multi-Organ transplants – unless investigational • pancreas Pancreas islet cell infusion • Meniscal Allograft • Autologous Chondrocyte Implantation – knee only • Hematopoietic Transplant Benefits are Covered for: o Bone Marrow Transplant including peripheral blood bone marrow stem cell harvesting and transplantation (stem cell transplant) following high dose chemotherapy. Bone marrow transplants are Covered for the following indications: o multiple Multiple myeloma o leukemia Leukemia o aplastic Aplastic anemia o lymphoma Lymphoma o severe Severe combined immunodeficiency disease (SCID) o Wiskott Xxxxxxx syndrome x Xxxxx’x Sarcoma o germ Germ cell tumor o neuroblastoma Neuroblastoma o Wilms Tumor o myelodysplastic Myelodysplastic Syndrome o myelofibrosis Myelofibrosis o sickle Sickle cell disease o thalassemia Thalassemia major If there is a living donor that requires surgery to make an Organ available for a Covered transplant for our Member, Coverage is available for expenses incurred by the living donor for surgery, laboratory and X-ray services, Organ storage expenses, and Inpatient follow-up care only. We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy. $150 per day for the transplant recipient, live donor and one other person combined. Benefits will only be Covered for transportation, lodging and meals and are limited to a lifetime maximum of $10,000. All Organ transplants must be performed at site that we approve and require Prior Authorization.

Transplants. This benefit has one or more exclusions as specified in the Exclusions Section. All Organ transplants must be performed at an approved center and require Prior Authorization. Human Solid Organ transplant benefits are Covered for: • · Kidney • · Liver • · Pancreas • · Intestine • · Heart • · Lung • multi· Multi-visceral (3 three or more abdominal Organs) • simultaneous · Simultaneous multi-Organ transplants – unless investigational • pancreas · Pancreas islet cell infusion • · Meniscal Allograft • · Autologous Chondrocyte Implantation – knee only • · Hematopoietic Transplant Benefits are Covered for: o Bone Marrow Transplant including peripheral blood bone marrow stem cell harvesting and transplantation (stem cell transplant) following high dose chemotherapy. Bone marrow transplants are Covered for the following indications: o multiple Multiple myeloma o leukemia Leukemia o aplastic Aplastic anemia o lymphoma Lymphoma o severe Severe combined immunodeficiency disease (SCID) o Wiskott Xxxxxxx syndrome x Xxxxx’x Sarcoma o germ Germ cell tumor o neuroblastoma Neuroblastoma o Wilms Tumor o myelodysplastic Myelodysplastic Syndrome o myelofibrosis Myelofibrosis o sickle Sickle cell disease o thalassemia Thalassemia major If there is a living donor that requires surgery to make an Organ available for a Covered transplant for our Member, Coverage is available for expenses incurred by the living donor for surgery, laboratory and X-ray services, Organ storage expenses, and Inpatient follow-up care only. We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy. $150 per day for the transplant recipient, live donor and one other person combined. Benefits will only be Covered for transportation, lodging and meals and are limited to a lifetime maximum of $10,000. All Organ transplants must be performed at site that we approve and require Prior Authorization.

Transplants. This benefit has one or more exclusions as specified in the Exclusions Section. All Organ transplants must be performed at an approved center and require Prior Authorization. Human Solid Organ transplant benefits are Covered for: • Kidney • Liver • Pancreas • Intestine • Heart • Lung • multi-visceral (3 or more abdominal Organs) • simultaneous multi-Organ transplants – unless investigational • pancreas islet cell infusion • Meniscal Allograft • Autologous Chondrocyte Implantation – knee only • Bone Marrow Transplant including peripheral blood bone marrow stem cell harvesting and transplantation (stem cell transplant) following high dose chemotherapy. Bone marrow transplants are Covered for the following indications: o multiple myeloma o leukemia o aplastic anemia o lymphoma o severe combined immunodeficiency disease (SCID) o Wiskott Xxxxxxx syndrome x Xxxxx’x Sarcoma o germ cell tumor o neuroblastoma o Wilms Tumor o myelodysplastic Syndrome o myelofibrosis o sickle cell disease o thalassemia major If there is a living donor that requires surgery to make an Organ available for a Covered transplant for our Member, Coverage is available for expenses incurred by the living donor for surgery, laboratory and X-ray services, Organ storage expenses, and Inpatient follow-up care only. We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy. $150 per day for the transplant recipient, live donor and one other person combined. Benefits will only be Covered for transportation, lodging and meals and are limited to a lifetime maximum of $10,000. All Organ transplants must be performed at site that we approve and require Prior Authorization.