Reconstructive Surgery Services definition

Reconstructive Surgery Services section of the Traditional, Deductible and High Deductible Health Plan EOCs has been modified to specify that Services are covered when prescribed by a Participating Physician and are subject to Utilization Review. The word significant has been removed in this section for consistency across products. Services are covered based upon Utilization Review.  The “Custodial Services” exclusion in the “Exclusions and Limitations” section of the EOC has been changed to “Custodial Care.” The exclusion has also been modified to align across lines of business for Member clarity.  The phrase “not subject to Deductible” has been removed from several rows of the “Benefit Summary” for contract integrity and continuity. Our contract convention is to specify when benefits are subject to the Deductible and to not reference the Deductible when it does not apply. The “What You Pay” section of the EOC notes that the “Benefit Summary” indicates which Services are subject to the Deductible.  The “Deductible” section of the “Benefit Summary” has been modified to describe all accumulation types in terms of a self-only Deductible, an individual Family Member Deductible, and a Family Deductible. Aggregate accumulation is represented when the individual Family Member Deductible amount equals the Family Deductible amount. Embedded accumulation is represented when the self- only Deductible amount equals the individual Family Member Deductible amount.  The “Out-of-Pocket Maximum” section of the “Benefit Summary” has been modified to describe all accumulation types in terms of a self-only Out-of-Pocket Maximum, an individual Family Member Out- of-Pocket Maximum, and a Family Out-of-Pocket Maximum. Aggregate accumulation is represented when the individual Family Member Out-of-Pocket Maximum amount equals the Family Out-of-Pocket Maximum amount. Embedded accumulation is represented when the self-only Out-of-Pocket Maximum amount equals the individual Family Member Out-of-Pocket Maximum amount.  The Emergency Services row of the “Benefit Summary” has been changed to emergency department visit to more accurately reflect when the emergency department visit Copayment or Coinsurance applies.
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Reconstructive Surgery Services section of the EOC has been modified to align with other sections within the EOC. Language has been moved and modified to specify that Services are subject to Utilization Review by Company. The word significant has been removed in this section for consistency across products. Services are covered based upon Utilization Review.  The “Custodial Care” exclusion in the “Exclusions and Limitations” section of the EOC has been modified to align across lines of business and for Member clarity.  A sentence has been added to the “Benefit Summary” to clarify that all applicable visit limits are combined across both tiers, unless otherwise indicated in the EOC. Language has been removed from the left column of the “Benefit Summary” table indicating “both tiers combined.”  The “Limited Outpatient Prescription Drugs and Supplies” section of the “Benefit Summary” has been modified for better alignment with the “Outpatient Prescription Drug Rider” to more accurately reflect that these drugs may be obtained from Medimpact or Xxxxxx Permanente Pharmacies. Administrative changes or clarifications  The “Limited Outpatient Prescription Drugs and Supplies” section of the “Benefit Summary” has been modified for accuracy. The word “formulary” has been removed from the row for contraceptive drugs. In addition to Xxxxxx Permanente Pharmacies, this section represents limited prescription drugs and supplies received from MedImpact Pharmacies, which are not subject to the formulary. Changes and clarifications that apply to medical benefit riders Benefit clarifications
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Reconstructive Surgery Services section has been modified to remove the age limit for treating port wine stains on the face.
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Examples of Reconstructive Surgery Services in a sentence

  • Breast Reconstructive Surgery Services and Breast Cancer Long-Term Survivorship Care 1.

  • Yes Non-Cosmetic Reconstructive Surgery Services begin within 1 year of the accident; Benefit does not include personal comfort items and room and board when temporary leave permitted.

  • Copayments, Deductible Amounts, and Coinsurance are applicable.Breast Reconstructive Surgery Services and Breast Cancer Long-Term Survivorship Care‌ 1.

  • Specialty(ies)(As indicated on the Healthcare Facility Regulation Division or Office of Regulatory Services permit): Plastic & Reconstructive Surgery Services Provided: Aesthetic Surgery, Plastic Surgery, Ophthalmology Surgery, Surgical Oncology, and Otolaryngology Part F : Utilization & Revenue by Payer Source for Ambulatory Surgery Services 1.


More Definitions of Reconstructive Surgery Services

Reconstructive Surgery Services section of the EOC has been modified to align with other sections within the EOC. Language has been moved and modified to specify that Services are subject to Utilization Review by Company. The “Custodial Care” exclusion in the “Exclusions and Limitations” section of the EOC has been modified to align across lines of business and for Member clarity. A sentence has been added to the “Benefit Summary” to clarify that all applicable visit limits are combined across both tiers, unless otherwise indicated in the EOC. Language has been removed from the left column of the “Benefit Summary” table indicating “both tiers combined.” The “Limited Outpatient Prescription Drugs and Supplies” section of the “Benefit Summary” has been modified for better alignment with the “Outpatient Prescription Drug Rider” to more accurately reflect that these drugs may be obtained from Medimpact or Xxxxxx Permanente Pharmacies. Administrative changes or clarifications The “About the PPO Plus Network” section of the EOC has been modified for better alignment with RCW 48.43.510 and WAC 000-00-0000. Language has been added indicating that if a Member would like more information about health plan disclosures that they may contact Member Services or register at xx.xxx.
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Related to Reconstructive Surgery Services

  • Cemetery services means cremations, grave openings and closings, and installation of grave memorials.

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Habilitative services means those services provided by

  • Hospice services means palliative and supportive care and other services provided by an interdisciplinary team under the direction of an identifiable hospice administration to terminally ill hospice patients and their families to meet the physical, nutritional, emotional, social, spiritual, and special needs experienced during the final stages of illness, dying, and bereavement, as defined in Minnesota Statutes, § 144A.75, subd. 8, and includes the set of services as determined by the Medicare program under §1861(dd) of the Social Security Act and defined in 42 CFR § 418.3.

  • Rehabilitative services means specialized services provided by a therapist or a therapist’s assistant to a resident to attain optimal functioning, including, but not limited to, physical therapy, occupational therapy, speech and language therapy, and audiology.

  • Preventive services means preservation services, as defined

  • Rehabilitation services means face-to-face individual or group services provided by qualified staff to develop skill necessary to perform activities of daily living and successful integration into community life.

  • Basic health plan services means that schedule of covered

  • Preconstruction services means services and other activities during the design phase.

  • Pharmacy services means the practice of pharmacy as defined in chapter 18.64 RCW and includes any drugs or devices as defined in chapter 18.64 RCW.

  • Telehealth services means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the provider for telehealth is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.

  • Delivery Services means those services provided by the

  • Mental health services means interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development and enhanced self-sufficiency. Services shall include:

  • Access Services refers to interstate and intrastate switched access and private line transport services.

  • Respite services means a temporary period of relief and support for individuals and their families provided in a variety of settings. The intent is to provide a safe environment with staff assistance for individuals who lack an adequate support system to address current issues related to a disability. Respite may be provided for a defined period of time; respite is either planned or provided in response to a crisis.

  • Ambulance service means an entity, its personnel and equipment including, but not limited to, automobiles, airplanes, boats or helicopters, which are licensed to provide Emergency medical and Ambulance services in the state in which the services are rendered.

  • Homemaker services means the professionally directed or supervised simple household maintenance or management services provided by trained homemakers or individuals to families in their own homes.

  • Inpatient hospital services means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services;

  • Vocational rehabilitation services means professional services reasonably necessary during or after, or both during and after, medical treatment to enable a disabled injured employee to return to gainful employment as soon as practical. "Vocational rehabilitation services" includes vocational evaluation, retraining and job placement.

  • Dental Services means diagnostic, preventive, or corrective