Common use of You and Blue Cross & Blue Shield of Rhode Clause in Contracts

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). 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. 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. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). 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. 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. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be is eligible for coverage under this agreement: •  the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; •  final FDA approval; •  the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; •  submission to us of a claim meeting the criteria above; and • generally,  the first date an FDA approved prescription drug is generally available in pharmacies (for prescription drug coverage drugs only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). 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. 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. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be is eligible for coverage under this agreement: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is generally available in pharmacies (for prescription drug coverage drugs only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI)Island, agree to provide coverage for medically necessary covered health care services listed in this agreement. We only cover a service in this agreement if it is medically necessary. (The term medically necessary is defined in Section 8.0). ) 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. We This agreement only cover covers a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria of (a), (b) or (c) above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.27 3.28 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). 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. 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. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: •  the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; •  final FDA approval; •  the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; •  submission to us of a claim meeting the criteria above; and •  generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). ) 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. 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. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be is eligible for coverage under this agreement: •  the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; •  final FDA approval; •  the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; •  submission to us of a claim meeting the criteria above; and • generally,  the first date an FDA approved prescription drug is generally available in pharmacies (for prescription drug coverage drugs only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI)Island, agree to provide coverage for medically necessary covered health care services listed in this agreement. We only cover a service in this agreement if it is medically necessary. (The term medically necessary is defined in Section 8.0). 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. We This agreement only cover covers a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: •  the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; •  final FDA approval; •  the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; •  submission to us of a claim meeting the criteria of (a), (b) or (c) above; and •  generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.27 3.28 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.