Medicare Benefits definition

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an individual having entitlement thereto, who made claim therefore, or the equivalent of those benefits. Medicare Eligible Expenses means expenses of the kinds covered by Medicare Part A and B to the extent recognized as reasonable and medically necessary by Medicare. Outpatient means a Subscriber receiving Services under the direction of a Physician, but not as an Inpatient. Physician means any practitioner as defined under Medicare. Services means medically necessary health care services and medically necessary supplies furnished incident to those services. Sickness means an illness or disease of a covered person which first manifests itself after the effective date of the Agreement and while coverage is in effect. Skilled Nursing Facility means a facility which participates in the Medicare program and is licensed by the California Department of Health Services as a "Skilled Nursing Facility," or a similar institution licensed by another state, a United States Territory, or a foreign country. Subacute Care means skilled nursing or skilled rehabilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, occupational, or speech therapy; a coordinated program of multiple therapies or who have medical needs that require daily Registered Nurse monitoring. A facility which is primarily a rest home, convalescent facility, or home for the aged is not included. Subscriber means a person whose status is the basis for eligibility for membership in this Medicare Supplement Plan, who is enrolled by Blue Shield, and maintains coverage in accordance with this Agreement. Total Disability (or Totally Disabled) means the incapability of self-sustaining employment by reason of mental retardation or physical handicap. United States means all of the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa.

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Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an individual having entitlement thereto, who made claim there- fore, or the equivalent of those benefits. Medicare Eligible Expenses means expenses of the kinds covered by Medicare Part A and B to the extent recognized as reasonable and medically necessary by Medicare. Outpatient means a Subscriber receiving Ser- vices under the direction of a Physician, but not as an Inpatient. Physician means any practitioner as defined un- der Medicare. Services means medically necessary health care services and medically necessary supplies fur- nished incident to those services. Sickness means an illness or disease of a covered person which first manifests itself after the effec- tive date of the Agreement and while coverage is in effect. Skilled Nursing Facility means a facility which participates in the Medicare program and is li- censed by the California Department of Health Services as a "Skilled Nursing Facility," or a simi- lar institution licensed by another state, a United States Territory, or a foreign country. Subacute Care means skilled nursing or skilled rehabilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, occupa- tional, or speech therapy; a coordinated program of multiple therapies or who have medical needs that require daily Registered Nurse monitoring. A facility which is primarily a rest home, convales- cent facility, or home for the aged is not included. Subscriber means a person whose status is the basis for eligibility for membership in this Medi- care Supplement Plan, who is enrolled by Blue Shield, and maintains coverage in accordance with this Agreement. Total Disability (or Totally Disabled) means the incapability of self-sustaining employment by reason of mental retardation or physical handicap. United States means all of the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa.

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an individual having entitlement thereto, who made claim there- fore, or the equivalent of those benefits. Medicare Eligible Expenses means expenses of the kinds covered by Medicare Part A and B to the extent recognized as reasonable and medically nec- ▇▇▇▇▇▇ by Medicare. Outpatient means a Subscriber receiving Services under the direction of a Physician, but not as an In- patient. Physician means any practitioner as defined under Medicare. Services means medically necessary health care services and medically necessary supplies fur- nished incident to those services. Sickness means an illness or disease of a covered person which first manifests itself after the effec- tive date of the Agreement and while coverage is in effect. Skilled Nursing Facility means a facility which participates in the Medicare program and is li- Subacute Care means skilled nursing or skilled re- habilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, occupational, or speech therapy; a coordinated program of multiple therapies or who have medical needs that require daily Registered Nurse monitoring. A facility which is primarily a rest home, convalescent facil- ity, or home for the aged is not included. Subscriber means a person whose status is the ba- sis for eligibility for membership in this Medicare Supplement Plan, who is enrolled by Blue Shield, and maintains coverage in accordance with this Agreement. Total Disability (or Totally Disabled) means the incapability of self-sustaining employment by rea- son of mental retardation or physical handicap. United States means all of the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa. VSP Non-Participating Provider means a li- censed ophthalmologist, optometrist, or dispensing optician who has not certified and not accepted the terms of the Agreement. VSP Participating Provider means a licensed ophthalmologist, optometrist, or optician who has certified his willingness to accept the terms and conditions and compensations as payment in full for covered services as set forth in the VSP con- tract.

Examples of Medicare Benefits in a sentence

Benefits for the coverage listed above shall be paid when the Subscriber is not entitled to payment for such Services under Medicare by reason of exhaustion of Medicare Benefits or reductions for coinsurance and Deductibles required under Medicare.
Requests for payments must be sub- mitted to Blue Shield by the Physician, Hospital or the Subscriber within one (1) year after the month in which Services are rendered or the date of pro- cessing of Medicare Benefits.
Requests for payments must be submitted to Blue Shield by the Physician, Hospi- tal or the Subscriber within one (1) year after the month in which Services are rendered or the date of processing of Medicare Benefits.
Benefits for the coverage listed above shall be paid when the Subscriber is not entitled to payment for such Services under Medicare by reason of exhaustion of Medicare Benefits or reductions for coinsurance and Deducti- bles required under Medicare.
Requests for payments must be submitted to Blue Shield by the Physician, Hospital or the Subscriber within one (1) year after the month in which Services are rendered or the date of processing of Medicare Benefits.

More Definitions of Medicare Benefits

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an in- dividual having entitlement thereto, who made claim therefore, or the equivalent of those bene- fits. MEDICARE ELIGIBLE EXPENSES means OUTPATIENT means a Subscriber receiving Services under the direction of a Physician, but not as an Inpatient. PHYSICIAN means any practitioner as defined under Medicare. SERVICES means medically necessary health care services and medically necessary supplies furnished incident to those services. SICKNESS means an illness or disease of a cov- ered person which first manifests itself after the effective date of the Agreement and while cover- age is in effect. SKILLED NURSING FACILITY means a fa- SUBACUTE CARE means skilled nursing or skilled rehabilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, oc- cupational, or speech therapy; a coordinated pro- gram of multiple therapies or who have medical needs that require daily Registered Nurse moni- toring. A facility which is primarily a rest home, convalescent facility, or home for the aged is not included.

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an individual having entitlement thereto, who made claim therefore, or the equivalent of those benefits. Medicare Eligible Expenses means expenses of the kinds covered by Medicare Part A and B to the Outpatient means a Subscriber receiving Services under the direction of a Physician, but not as an Inpatient. Physician means any practitioner as defined under Medicare. Services means medically necessary health care services and medically necessary supplies furnished incident to those services. Sickness means an illness or disease of a covered person which first manifests itself after the effective date of the Agreement and while coverage is in effect. Skilled Nursing Facility means a facility which participates in the Medicare program and is licensed by the California Department of Health Services as a "Skilled Nursing Facility," or a similar institution licensed by another state, a United States Territory, or a foreign country. Subacute Care means skilled nursing or skilled rehabilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, occupational, or speech therapy; a coordinated program of multiple therapies or who have medical needs that require daily Registered Nurse monitoring. A facility which is primarily a rest home, convalescent facility, or home for the aged is not included. Subscriber means a person whose status is the basis for eligibility for membership in this Medicare Supplement Plan, who is enrolled by Blue Shield, and maintains coverage in accordance with this Agreement. Total Disability (or Totally Disabled) means the incapability of self-sustaining employment by reason of mental retardation or physical handicap. United States means all of the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa.

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part

Medicare Benefits means benefits for services and supplies which the Eligible Person receives or is entitled to receive under Medicare Part A or B.

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an individual having entitlement thereto, who made claim therefore, or the equivalent of those benefits. Medicare Eligible Expenses means expenses of the kinds covered by Medicare Part A and B to the extent recognized as reasonable and medically necessary by Medicare. Outpatient means a Subscriber receiving Services under the direction of a Physician, but not as an Inpatient. Physician means any practitioner as defined under Medicare. Services means medically necessary health care services and medically necessary supplies furnished incident to those services. Sickness means an illness or disease of a covered person which first manifests itself after the effective date of the Agreement and while coverage is in effect. Skilled Nursing Facility means a facility which participates in the Medicare program and is licensed by the California Department of Health Subacute Care means skilled nursing or skilled rehabilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, occupational, or speech therapy; a coordinated program of multiple therapies or who have medical needs that require daily Registered Nurse monitoring. A facility which is primarily a rest home, convalescent facility, or home for the aged is not included. Subscriber means a person whose status is the basis for eligibility for membership in this Medicare Supplement Plan, who is enrolled by Blue Shield, and maintains coverage in accordance with this Agreement. Total Disability (or Totally Disabled) means the incapability of self-sustaining employment by reason of mental retardation or physical handicap. United States means all of the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa.

Medicare Benefits means those benefits actually provided under Part A (hospital benefits) or Part B (medical benefits) of Medicare to an individual having entitlement thereto, who made claim therefore, or the equivalent of those benefits. Medicare Eligible Expenses means expenses of the kinds covered by Medicare Part A and B to the extent recognized as reasonable and medically necessary by Medicare. Outpatient means a Subscriber receiving Services under the direction of a Physician, but not as an Inpatient. Physician means any practitioner as defined under Medicare. Services means medically necessary health care services and medically necessary supplies furnished incident to those services. Sickness means an illness or disease of a covered person which first manifests itself after the Skilled Nursing Facility means a facility which participates in the Medicare program and is licensed by the California Department of Health Services as a "Skilled Nursing Facility," or a similar institution licensed by another state, a United States Territory, or a foreign country. Subacute Care means skilled nursing or skilled rehabilitative care provided in a hospital or skilled nursing facility to patients who require skilled care such as nursing services, physical, occupational, or speech therapy; a coordinated program of multiple therapies or who have medical needs that require daily Registered Nurse monitoring. A facility which is primarily a rest home, convalescent facility, or home for the aged is not included. Subscriber means a person whose status is the basis for eligibility for membership in this Medicare Supplement Plan, who is enrolled by Blue Shield, and maintains coverage in accordance with this Agreement. Total Disability (or Totally Disabled) means the incapability of self-sustaining employment by reason of mental retardation or physical handicap. United States means all of the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa. VSP Non-Participating Provider means a licensed ophthalmologist, optometrist, or dispensing optician who has not certified and not accepted the terms of the Agreement. VSP Participating Provider means a licensed ophthalmologist, optometrist, or optician who has certified his willingness to accept the terms and conditions and compensations as payment in full for covered services as set forth in the VSP contract.