Covered benefit definition

Covered benefit or “benefit” means those health care services to which a covered person is entitled under the terms of a health benefit plan.

Covered benefit means that you can get this service through AHCCCS and Arizona Complete Health-Complete Care Plan. “Medically Necessary” means that a covered service is provided by a physician or other licensed practitioner of the healing arts within the scope of practice under state law to prevent disease, disability or other adverse health conditions or their progression, or prolong life.

Covered benefit means an enrollee’s entitlement to payment for or provision of health services as defined in an agreement with a health plan. Covered benefit shall have the same meaning as covered service.

Examples of Covered benefit in a sentence

• If We have denied coverage on the basis that a service is not Medically Necessary (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment (including clinical trials and treatments for rare diseases), You or Your representative may appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these appeals.

• If We have denied coverage on the basis that a service does not meet Our requirements for Medical Necessity (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment(including clinical trials and treatments for rare diseases), You or Your representative may appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these appeals.

• Under your plan, use of an Out-of-network Provider to prescribe or dispense contraceptive coverage is a Covered benefit.

• Emergency ambulance services are a Covered benefit when they are considered Medically Necessary and at least one of the following criteria are met: • You are transported by a state licensed vehicle that is designed, equipped, and used only to transport the sick and injured and staffed by Emergency Medical Technicians (EMT), paramedics, or other certified professionals.

• If We have denied coverage on the basis that a service is not Medically Necessary (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment (including clinical trials and treatments for rare diseases); or is an out-of-network treatment, You or Your representative may Appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these Appeals.

More Definitions of Covered benefit

Covered benefit or “benefit” means those health care services to which a covered person

Covered benefit means each of (a) the Premium Conversion Benefit, (b) the Dependent Care Assistance Program, (c) the Health Flexible Spending Arrangement, and (d) the HSA Contribution Benefit. The rules regarding the Premium Conversion Benefit, the Dependent Care Assistance Program, the Health Flexible Spending Arrangement and the HSA Contribution Benefit are described in more detail in the Plan and this Summary. However, the rules regarding benefits coverage under the Oxy Welfare Plan (which underlies the Premium Conversion Benefit) are set forth in the separate governing documents of the Oxy Welfare Plan. You can obtain a copy of certain documents regarding the Oxy Welfare Plan upon written request to the OxyLink Employee Service Center (see contact information in Article XII).

Covered benefit or "benefit" means those mental healthcare services or substance abuse services to which a covered person is entitled under the terms of a health benefit plan;

Covered benefit means a health care service for which an enrollee is entitled to payment under the terms of a health care plan.

Covered benefit or "benefit" means the health care services to which a covered person is entitled under the terms of a health care insurance plan offered by a managed care organization.

Covered benefit means any benefit, eligible for reimbursement under the Premium Conversion Program, including contracts issued by Providers, and/or with the employer if the employer self-funds benefits under a plan.

Covered benefit or "benefit" means a health care service to which