Traveling Companion. A person whose presence as a companion or caregiver is necessary to enable a Member to receive services in connection with a Transplant on an inpatient or outpatient basis; or to travel to and from the IOE facility where treatment is provided. • Totally Disabled or Total Disability. A Member shall be considered Totally Disabled if:
Traveling Companion. A person whose presence as a companion or caregiver is necessary to enable a Member to receive services in connection with a Transplant on an inpatient or outpatient basis; or to travel to and from the IOE facility where treatment is provided. • Urgent Care. Non-preventive or non-routine health care services which are Covered Benefits and are required in order to prevent serious deterioration of a Member’s health following an unforeseen illness, injury or condition if: (a) the Member is temporarily absent from the HMO Service Area and receipt of the health care service cannot be delayed until the Member returns to the HMO Service Area; or, (b) the Member is within the HMO Service Area and receipt of the health care services cannot be delayed until the Member’s Primary Care Physician is reasonably available. AETNA HEALTH INC. (FLORIDA) HOME HEALTH CARE AMENDMENT Contract Holder Group Agreement Effective Date: January 1, 2010 The Aetna Health Inc. Certificate is hereby amended as follows:
Traveling Companion. A person whose presence as a companion or caregiver is necessary to enable a Member to receive services in connection with a Transplant on an inpatient or outpatient basis; or to travel to and from the IOE facility where treatment is provided. • Urgent Care. Non-preventive or non-routine health care services which are Covered Benefits and are required in order to prevent serious deterioration of a Member’s health following an unforeseen illness, injury or condition if: (a) the Member is temporarily absent from the HMO Service Area and receipt of the health care service cannot be delayed until the Member returns to the HMO Service Area; or, (b) the Member is within the HMO Service Area and receipt of the health care services cannot be delayed until the Member’s Primary Care Physician is reasonably available. AETNA HEALTH INC. (GEORGIA) HMO AETNA OPEN ACCESSTM RIDER Group Agreement Effective Date: January 1, 2013 HMO and Contract Holder agree to offer Member Covered Benefits under this self-referred plan as described below and subject to the provisions of this Rider. The Member may obtain certain Covered Benefits from Participating Providers without a Referral from their selected PCP. Item A under the HMO Procedure section of the Certificate is amended to delete the following sentence: Until a PCP is selected, benefits will be limited to coverage for Medical Emergency care. Item B under the HMO Procedure section of the Certificate is deleted and replaced with the following:
Traveling Companion. A person whose presence as a companion or caregiver is necessary to enable a Member to receive services in connection with a Transplant on an inpatient or outpatient basis; or to travel to and from the IOE facility where treatment is provided. • Urgent Care. Non-preventive or non-routine health care services which are Covered Benefits and are required in order to prevent serious deterioration of a Member’s health following an unforeseen illness, injury or condition if: (a) the Member is temporarily absent from the HMO Service Area and receipt of the health care service cannot be delayed until the Member returns to the HMO Service Area; or, (b) the Member is within the HMO Service Area and receipt of the health care services cannot be delayed until the Member’s Primary Care Physician is reasonably available. AETNA HEALTH INC. (FLORIDA) TERMINATION OF COVERAGE & DISPUTE RESOLUTION, CLAIMS PROCEDURE, COMPLAINTS AND APPEALS AND EXTERNAL REVIEW CERTIFICATE OF COVERAGE AMENDMENT Contract Holder Group Agreement Effective Date: January 1, 2013 The Aetna Health Inc. Certificate is hereby amended as follows:
Traveling Companion. A person whose presence as a companion or caregiver is necessary to enable a Member to receive services in connection with a Transplant on an inpatient or outpatient basis; or to travel to and from the IOE facility where treatment is provided. • Urgent Care. Non-preventive or non-routine health care services which are Covered Benefits and are required in order to prevent serious deterioration of a Member’s health following an unforeseen illness, injury or condition if: (a) the Member is temporarily absent from the HMO Service Area and receipt of the health care service cannot be delayed until the Member returns to the HMO Service Area; or, (b) the Member is within the HMO Service Area and receipt of the health care services cannot be delayed until the Member’s Primary Care Physician is reasonably available. AETNA HEALTH INC. (GEORGIA) CERTIFICATE OF COVERAGE AMENDMENT The Aetna Health Inc. HMO Certificate is amended as follows: The Definitions section of the Certificate is hereby amended to add the following:
