TREATMENT IN URGENCY CARE CENTERS AND CONVENIENCE CLINICS Sample Clauses

TREATMENT IN URGENCY CARE CENTERS AND CONVENIENCE CLINICS. Are the treatments received in classified Urgent Care Centers in the United States of America. This is a type of medical service center specializing in the diagnosis and treatment of serious or acute medical conditions, which generally require immediate attention; but do not pose an imminent risk to life or health. This service is an intermediate care between the primary doctor and the emergency service. Services in hospital emergency centers or others that are not Urgent Care will not be covered under this benefit.
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TREATMENT IN URGENCY CARE CENTERS AND CONVENIENCE CLINICS. Are the treatments received in classified Urgent Care Centers in the United States of America. This is a type of medical service center specializing in the diagnosis and treatment of serious or acute medical conditions, which generally require immediate attention; but do not pose an imminent risk to life or health. This service is an intermediate care between the primary doctor and the emergency service. Services in hospital emer- gency centers or others that are not Urgent Care will not be covered under this benefit. USUAL, CUSTOMARY, AND REASONABLE (UCR): It is the maximum amount the insurer will consider eligible for payment under a health insurance plan. This amount is determined based on a periodic review of the prevailing charges for a particular service adjusted for a specific region or geographical area. WE/US/OUR: Bupa Insurance Limited or USA Medical Services acting on behalf of Bupa Insurance Limited. WELL BABY CARE: Routine medical care provided to a healthy newborn.
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TREATMENT IN URGENCY CARE CENTERS AND CONVENIENCE CLINICS. Are the treatments received in classified Urgent Care Centers in the United States of America. This is a type of medical service center specializing in the diagnosis and treatment of serious or acute medical conditions, which gener- ally require immediate attention; but do not pose an imminent risk to life or health. This service is an intermediate care between the primary doctor and the emergency service. Services in hospital emergency centers or others that are not Urgent Care will not be covered under this benefit. CONTENIDO ACUERDO 26 BENEFICIOS 29 Tabla de beneficios 30 Provisiones de la póliza 31 EXCLUSIONES Y LIMITACIONES 36 ADMINISTRACIÓN 39 DEFINICIONES 44 BUPA PRESTIGE ACUERDO BUPA INSURANCE COMPANY :(de ahora en adelante denominada la “Compañía”) acuerda pagar a usted (de ahora en adelante denominado el "Titular del Contrato") los beneficios estipulados en este Contrato por cualquier tratamiento, servicio y suministro médico que se lleven a cabo en América Latina, el Caribe y los Estados Unidos de América. Todos los beneficios están sujetos a los términos y condiciones de este Contrato.
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TREATMENT IN URGENCY CARE CENTERS AND CONVENIENCE CLINICS. Are the treat-
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Related to TREATMENT IN URGENCY CARE CENTERS AND CONVENIENCE CLINICS

  • Emergency Care Services If you experience a medical emergency while traveling outside our service area, go to the nearest emergency or urgent care facility. When you receive Out-of-Area covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for the Out-of-Area Covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: • the billed charges for your Out-of-Area covered healthcare services; or • the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.

  • Emergency Care If you need emergency care, call 911 or go to the nearest hospital emergency room. If you are traveling outside our service area and need urgent care, call the Customer Service number provided in the chart above or visit our website and use the “Find A Doctor” feature to find a BlueCard provider.

  • Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received:  as an inpatient;  as an outpatient ;  in your home;  in a doctor’s office; or  from a pharmacy. Also coverage differs depending on whether:  the health care provider is a network provider or non-network provider;  deductibles (if any), copayments, or maximum benefit apply;  you have reached your plan year maximum out-of-pocket expense;  there are any exclusions from coverage that apply; or  our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.

  • STATEWIDE CONTRACT MANAGEMENT SYSTEM If the maximum amount payable to Contractor under this Contract is $100,000 or greater, either on the Effective Date or at any time thereafter, this section shall apply. Contractor agrees to be governed by and comply with the provisions of §§00-000-000, 00-000-000, 00-000-000, and 00- 000-000, C.R.S. regarding the monitoring of vendor performance and the reporting of contract information in the State’s contract management system (“Contract Management System” or “CMS”). Contractor’s performance shall be subject to evaluation and review in accordance with the terms and conditions of this Contract, Colorado statutes governing CMS, and State Fiscal Rules and State Controller policies.

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Required Procurement Procedures for Obtaining Goods and Services The Grantee shall provide maximum open competition when procuring goods and services related to the grant-assisted project in accordance with Section 287.057, Florida Statutes.

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