Urgent Care Situations Sample Clauses

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• Urgent Care This plan covers services received at an urgent care center. For other services, such as surgery or diagnostic tests, the amount that you pay is based on the type of service being provided. See Summary of Medical Benefits for details. Follow-up care (such as suture removal or wound care) should be obtained from your primary care provider or specialist.

• Urgent Care Services All Medically Necessary Covered Services received in Urgent Care Centers, Retail Clinics or your Primary Care Physician’s office after-hours to treat an Urgent Medical Condition will be covered by AvMed. Any request for reimbursement of payment made by a Member for services received must be filed within 90 days or as soon as reasonably possible but not later than one year unless the Member was legally incapacitated. If Urgent Medical Services and Care are required while outside the continental United States, Alaska or Hawaii, it is the Member’s responsibility to pay for such services at the time they are received. For information on filing a Claim for such services, see Part XIII. REVIEW PROCEDURES AND HOW TO APPEAL A CLAIM (BENEFIT) DENIAL.

• Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

• Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.

• Medically Necessary Services for the State plan services in Addendum VIII. B medically necessary has the meaning in Wis. Admin. Code DHS §101.03(96m): services (as defined under Wis. Stat. § 49.46

• STAFF ORIENTATION 4101 The Employer shall provide an appropriate orientation program for nurses newly employed. The orientation program shall include such essential information as policies, nursing procedures, the location of supplies and equipment, fire, safety and disaster plans. Where necessary, orientation shall be provided for nurses moving to a new area of practice. 4102 The Employer shall provide a program of inservice education for nurses pertinent to patient care. 4103 The Employer shall provide, access to reference materials as is required in relation to maintaining current knowledge of general nursing care. APPENDIX "A" - SALARIES A1. Effective April 1, 2013 - Monthly salaries include a 2% general increase. - Hourly salary is calculated as (monthly salary x 12) ÷ annual hours. Nurse Classification Annual Hours Start Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 20 Year 1 Licensed Practical Nurse 2015 Hourly 25.198 26.022 26.836 27.825 28.732 29.745 30.804 31.420 Monthly 4,231.164 4,369.528 4,506.212 4,672.281 4,824.582 4,994.681 5,172.505 5,275.942 Annual 50,773.970 52,434.330 54,074.540 56,067.375 57,894.980 59,936.175 62,070.060 63,311.300 Nurse II 2015 Hourly 32.917 34.066 35.218 36.419 37.593 38.811 39.587 Monthly 5,527.313 5,720.249 5,913.689 6,115.357 6,312.491 6,517.014 6,647.317 Annual 66,327.755 68,642.990 70,964.270 73,384.285 75,749.895 78,204.165 79,767.805 Nurse II (20 Year Scale) 2015 Hourly 33.575 34.747 35.923 37.148 38.345 39.587 Monthly 5,637.802 5,834.600 6,032.070 6,237.768 6,438.765 6,647.317 Annual 67,653.625 70,015.205 72,384.845 74,853.220 77,265.175 79,767.805 Nurse III 2015 Hourly 34.168 35.321 36.523 37.697 38.787 39.975 41.201 42.025 Monthly 5,737.377 5,930.985 6,132.820 6,329.955 6,512.984 6,712.469 6,918.335 7,056.698 Annual 68,848.520 71,171.815 73,593.845 75,959.455 78,155.805 80,549.625 83,020.015 84,680.375 Nurse III (20 Year Scale) 2015 Hourly 34.851 36.027 37.254 38.451 39.563 40.775 42.025 Monthly 5,852.064 6,049.534 6,255.568 6,456.564 6,643.287 6,846.802 7,056.698 Annual 70,224.765 72,594.405 75,066.810 77,478.765 79,719.445 82,161.625 84,680.375 Nurse IV 2015 Hourly 35.340 36.649 37.959 39.387 41.024 42.612 44.273 45.158 Monthly 5,934.175 6,153.978 6,373.949 6,613.734 6,888.613 7,155.265 7,434.175 7,582.781 Annual 71,210.100 73,847.735 76,487.385 79,364.805 82,663.360 85,863.180 89,210.095 90,993.370 Nurse IV (20 Year Scale) 2015 Hourly 36.047 37.382 38.718 40.175 41.844 43.464 45.158 Monthly 6,052.892 6,277.061 6,501.398 6,746.052 7,026.305 7,298.330 7,582.781 Annual 72,634.705 75,324.730 78,016.770 80,952.625 84,315.660 87,579.960 90,993.370 Nurse V 2015 Hourly 37.305 38.733 40.369 41.957 43.690 45.388 47.157 48.100 Monthly 6,264.131 6,503.916 6,778.628 7,045.280 7,336.279 7,621.402 7,918.446 8,076.792 Annual 75,169.575 78,046.995 81,343.535 84,543.355 88,035.350 91,456.820 95,021.355 96,921.500 Nurse V (20 Year Scale) 2015 Hourly 38.051 39.508 41.177 42.797 44.564 46.296 48.100 Monthly 6,389.397 6,634.052 6,914.305 7,186.330 7,483.038 7,773.870 8,076.792 Annual 76,672.765 79,608.620 82,971.655 86,235.955 89,796.460 93,286.440 96,921.500 Nurse Practitioner 2015 Hourly 42.515 45.635 47.511 49.385 51.408 52.437 Monthly 7,138.977 7,662.877 7,977.889 8,292.565 8,632.260 8,805.046 Annual 85,667.725 91,954.525 95,734.665 99,510.775 103,587.120 105,660.555 Nurse Practitioner (20 Year Scale) 2015 Hourly 43.365 46.548 48.461 50.373 52.437 Monthly 7,281.706 7,816.185 8,137.410 8,458.466 8,805.046 Annual 87,380.475 93,794.220 97,648.915 101,501.595 105,660.555 Weekend Worker Rates Annual Hours Start Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 20 Year 1 Weekend Worker - Licensed Practical Nurse 2015 Hourly 28.977 29.925 30.861 31.999 33.042 34.206 35.425 36.133 Monthly 4,865.721 5,024.906 5,182.076 5,373.165 5,548.303 5,743.758 5,948.448 6,067.333 Annual 58,388.655 60,298.875 62,184.915 64,477.985 66,579.630 68,925.090 71,381.375 72,807.995 Weekend Worker - Nurse II 2015 Hourly 37.855 39.176 40.501 41.882 43.232 44.633 45.526 Monthly 6,356.485 6,578.303 6,800.793 7,032.686 7,259.373 7,494.625 7,644.574 Annual 76,277.825 78,939.640 81,609.515 84,392.230 87,112.480 89,935.495 91,734.890 Weekend Worker - Nurse II (20 Year Scale) 2015 Hourly 38.612 39.959 41.311 42.720 44.097 45.526 Monthly 6,483.598 6,709.782 6,936.805 7,173.400 7,404.621 7,644.574 Annual 77,803.180 80,517.385 83,241.665 86,080.800 88,855.455 91,734.890 Weekend Worker - Nurse III 2015 Hourly 39.293 40.619 42.002 43.352 44.605 45.971 47.381 48.329 Monthly 6,597.950 6,820.607 7,052.836 7,279.523 7,489.923 7,719.297 7,956.060 8,115.245 Annual 79,175.395 81,847.285 84,634.030 87,354.280 89,879.075 92,631.565 95,472.715 97,382.935 Weekend Worker - Nurse III (20 Year Scale) 2015 Hourly 40.079 41.431 42.842 44.219 45.497 46.891 48.329 Monthly 6,729.932 6,956.955 7,193.886 7,425.107 7,639.705 7,873.780 8,115.245 Annual 80,759.185 83,483.465 86,326.630 89,101.285 91,676.455 94,485.365 97,382.935 Weekend Worker - Nurse IV 2015 Hourly 40.641 42.146 43.653 45.295 47.177 49.003 50.914 51.932 Monthly 6,824.301 7,077.016 7,330.066 7,605.785 7,921.805 8,228.420 8,549.309 8,720.248 Annual 81,891.615 84,924.190 87,960.795 91,269.425 95,061.655 98,741.045 102,591.710 104,642.980 Weekend Worker - Nurse IV (20 Year Scale) 2015 Hourly 41.454 42.989 44.526 46.201 48.121 49.983 51.932 Monthly 6,960.818 7,218.570 7,476.658 7,757.918 8,080.318 8,392.979 8,720.248 Annual 83,529.810 86,622.835 89,719.890 93,095.015 96,963.815 100,715.745 104,642.980 Weekend Worker - Nurse V 2015 Hourly 42.900 44.543 46.425 48.251 50.244 52.196 54.230 55.315 Monthly 7,203.625 7,479.512 7,795.531 8,102.147 8,436.805 8,764.578 9,106.121 9,288.310 Annual 86,443.500 89,754.145 93,546.375 97,225.765 101,241.660 105,174.940 109,273.450 111,459.725 Weekend Worker - Nurse V (20 Year Scale) 2015 Hourly 43.758 45.434 47.353 49.216 51.249 53.240 55.315 Monthly 7,347.698 7,629.126 7,951.358 8,264.187 8,605.561 8,939.883 9,288.310 Annual 88,172.370 91,549.510 95,416.295 99,170.240 103,266.735 107,278.600 111,459.725 1 Eligibility for the 20 Year increment is determined in accordance w ith Article 2105.

• Medical Exams 18.1: The Sheriff's Department may require a physical and/or psychological exam by a doctor, at the Employer's expense, to determine the employee's ability to perform his/her regular duties, if deemed appropriate. The employee may obtain a second opinion, at the employee's expense, and in the event there is a dispute between the Employer's doctor and the employee's doctor, both of these doctors shall select a third doctor, whose decision shall be final and binding on the parties. The expense for the third doctor's opinion shall be split 50-50 by the Employer and the employee if not covered by the employee's insurance.

• 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.

• Preventive Care and Early Detection Services This plan covers, early detection services, preventive care services, and immunizations or vaccinations in accordance with state and federal law, including the Affordable Care Act (ACA), as set forth below and in accordance with the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); or • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services and adult and pediatric immunizations or vaccinations are based on the most currently available guidelines and are subject to change. The amount you pay for preventive services will be different from the amount you pay for diagnostic procedures and non-preventive services. See the Summary of Medical Benefits and the Summary of Pharmacy Benefits for more information about the amount you pay. Preventive Office Visits This plan covers the following preventive office visits. • Annual preventive visit - one (1) routine physical examination per plan year per member age 36 months and older; • Pediatric preventive office and clinic visits from birth to 35 months - 11 visits; • Well Woman annual preventive visit - one (1) routine gynecological examination per plan year per female member.

• Habilitative Services Habilitative Services are healthcare services that help you keep, learn, or improve skills and functioning for daily living. These services are Covered and may require Prior Authorization. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.