Urgently Needed Services Sample Clauses
The 'Urgently Needed Services' clause defines the coverage and procedures for obtaining medical care in situations where immediate attention is required, typically when the patient is outside their usual service area. This clause generally applies to emergency or unforeseen medical conditions that cannot wait until the patient returns to their primary care network, such as sudden illness or injury while traveling. Its core function is to ensure that individuals can access necessary medical treatment in urgent situations without facing coverage denials or excessive delays, thereby protecting their health and providing peace of mind during emergencies.
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Urgently Needed Services. Covered Services required in order to prevent a serious deterioration of an HMO Member’s health that results from an unforeseen illness or injury if (i) such Member is temporarily absent from the Service Area and (ii) receipt of the health care service cannot be delayed until the Member’s return to the Service Area.
Urgently Needed Services a) The Contractor is responsible for Urgently Needed Services.
b) Urgently Needed Services are covered only in the United States, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and Canada.
c) The Contractor must disclose to all Enrollees the procedures to be followed to obtain Urgently Needed Services.
Urgently Needed Services. Payor shall pay for all Covered Services constituting Urgently Needed Services rendered to a Member. [42 C.F.R. § 422.100(b).]
Urgently Needed Services. Urgently Needed Services are defined as those services that are provided to you when: You are absent from the PACE CNY service area And You believe that the care cannot wait until you return to the PACE CNY service area, but the condition does not put your life or function in danger.
Urgently Needed Services those Covered Services provided when an enrollee is temporarily absent from Plan's service (or if applicable, continuation) area (or, for unusual or extraordinary circumstances, provided when the enrollee is in the service or continuation area but Plan's provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and immediately required; (1) as a result of an unforeseen illness, injury, or condition; and (2) it was not reasonable given the circumstances to obtain the services through Plan.
Urgently Needed Services. Covered Services that are not Emergency Services, provided when a Member is temporarily absent from the licensed service area (or, if applicable, Continuation Area) (or provided when a Member is in the licensed service area or Continuation Area, but Cigna-HealthSpring’s provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and immediately required as a result of an unforeseen illness, injury, or condition, and it was not reasonable given the circumstances to obtain the services from a Cigna-HealthSpring Participating Provider. [42 C.F.R. § 422.113(b)(1)(iii).]
Urgently Needed Services. “Urgently Needed Services” means Covered Services that are not Emergency Services that are provided when an enrollee is temporarily absent from the Priority Health service area when the services are medically necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable given the circumstances to obtain the services through Priority Health Participating Providers.
Urgently Needed Services a) The Contractor is responsible for Urgently Needed Services.
b) Urgently Needed Services are covered only in the United States, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and Canada.
c) The Contractor must disclose to all Enrollees the procedures to be followed to obtain Urgently Needed Services. (BENEFIT PACKAGE, COVERED AND NON-COVERED SERVICES) October 1, 2004 10-17
d) The Contractor may require Enrollees or the Enrollee's designee to coordinate with the Contractor or the Enrollee's PCP prior to receiving care, to ensure that the needed care will be authorized and covered by the plan as Urgently Needed Services.
Urgently Needed Services. Covered Medical Services provided when a Medicare+Choice Member is temporarily absent from the RPO Service Area (or, if applicable, Continuation Area) (or, under unusual and extraordinary circumstances, provided when a Medicare+Choice Member is in the RPO Service Area or Continuation Area, but Texas HealthSpring's provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and required without delay in order to prevent the serious deterioration of a Medicare+Choice Member's health as a result of an unforeseen illness, injury, or condition and it was not reasonable given the circumstances to obtain the services through Texas HealthSpring.
Urgently Needed Services. Cigna-HealthSpring shall pay for all Covered Services constituting Urgently Needed Services rendered to a Member. [42 C.F.R. § 422.100(b).]