Mental Health and Substance Use Disorder Sample Clauses

Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient, Outpatient, and Day Treatment Program services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be:
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Mental Health and Substance Use Disorder. Inpatient* – Services are considered inpatient when you are admitted to a facility. Refer to your Schedule of Benefits for Cost Share information. Professional Services (for example, doctors) may be billed separately from the facility charges. Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Mental Health and Substance Use Disorder: Outpatient – Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Refer to your Schedule of Benefits for Cost Share information. Mental Health and Substance Use Disorder Services* – The Plan covers Medically Necessary treatment of Mental Health conditions and Substance Use Disorders. Refer to the Benefit Exclusions section for more information on Services not covered by this Plan. This Plan covers, but is not limited to, the following Services: • Assessment and evaluation in order to diagnose or determine if a Mental Health condition or Substance Use Disorder exists; • Treatment of Mental Health conditions or Substance Use Disorders which are subject to significant improvement through evidence-based therapeutics; • Treatment provided in healthcare facilities, Residential programs or facilities, day or Partial Hospitalization programs, or Intensive Outpatient Services; • Treatment provided at a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited wilderness therapy program that has been licensed by the State of Oregon as Residential treatment for Mental Health and addiction Services. Samaritan Health Plans covers Services and treatment for those Mental Health and Substance Use Disorder diagnoses covered under the Mental Health and Addiction Equity Act of 2008. Samaritan Health Plans is compliant with state and federal Mental Health parity. Multidisciplinary Programs* – Include, but are not limited to, pain management, and child development and rehabilitation center (CDRC) programs. Services usually consist of a team of providers coordinating and working for the benefit of one Member. These programs do not require an authorization; however, some Services done as a result of treatment can require Prior Authorization. Specific Services that are a part of the Member’s treatment plan can require authorization; for example, MRIs, Hospitalizations, or genetic testing, and any other Services on the Prior Authorization list. Refer to the Prior Authorization section for more information. Cov...

Related to Mental Health and Substance Use Disorder

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Cardiac Rehabilitation Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible Chiropractic Services In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Dental Services - Accidental Injury (Emergency) Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Dental Services- Outpatient Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Dialysis Services Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Durable Medical Equipment (DME), Medical Supplies, Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Early Intervention Services (EIS) Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Education - Asthma Asthma management 0% - After deductible 40% - After deductible Emergency Room Services Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.

  • SUBSTANCE ABUSE The dangers and costs that alcohol and other chemical abuses can create in the electrical contracting industry in terms of safety and productivity are significant. The parties to this Agreement resolve to combat chemical abuse in any form and agree that, to be effective, programs to eliminate substance abuse and impairment should contain a strong rehabilitation component. The local parties recognize that the implementation of a drug and alcohol policy and program must be subject to all applicable federal, state, and local laws and regulations. Such policies and programs must also be administered in accordance with accepted scientific principles, and must incorporate procedural safeguards to ensure fairness in application and protection of legitimate interests of privacy and confidentiality. To provide a drug-free workforce for the Electrical Construction Industry, each IBEW local union and NECA chapter shall implement an area-wide Substance Abuse Testing Policy. The policy shall include minimum standards as required by the IBEW and NECA. Should any of the required minimum standards fail to comply with federal, state, and/or local laws and regulations, they shall be modified by the local union and chapter to meet the requirements of those laws and regulations.

  • Substance Abuse Program The SFMTA General Manager or designee will manage all aspects of the FTA-mandated Substance Abuse Program. He/she shall have appointing and removal authority over all personnel working for the Substance Abuse Program personnel, and shall be responsible for the supervision of the SAP.

  • Workplace Violence Prevention and Crisis Response (applicable to any Party and any subcontractors and sub-grantees whose employees or other service providers deliver social or mental health services directly to individual recipients of such services): Party shall establish a written workplace violence prevention and crisis response policy meeting the requirements of Act 109 (2016), 33 VSA §8201(b), for the benefit of employees delivering direct social or mental health services. Party shall, in preparing its policy, consult with the guidelines promulgated by the U.S. Occupational Safety and Health Administration for Preventing Workplace Violence for Healthcare and Social Services Workers, as those guidelines may from time to time be amended. Party, through its violence protection and crisis response committee, shall evaluate the efficacy of its policy, and update the policy as appropriate, at least annually. The policy and any written evaluations thereof shall be provided to employees delivering direct social or mental health services. Party will ensure that any subcontractor and sub-grantee who hires employees (or contracts with service providers) who deliver social or mental health services directly to individual recipients of such services, complies with all requirements of this Section.

  • Substance Abuse Treatment Information Substance abuse treatment information shall be maintained in compliance with 42 C.F.R. Part 2 if the Party or subcontractor(s) are Part 2 covered programs, or if substance abuse treatment information is received from a Part 2 covered program by the Party or subcontractor(s).

  • Accident Prevention Health and Safety Committee The Employer and the Union agree that they mutually to maintain standards of safety and health in the Hospital in order to prevent accidents, injury, and illness. ected or Recognizing its responsibilities under the applicable legislation, the Hospital agrees to accept as a member of its Accident Prevention Health and Safety Committee, at least one (1) representative sel appointed by the Union from amongst Bargaining Unit employees. Such Committee shall identify potential dangers and means of improving health and safety programs, and recommend actions to be taken to improve conditions related to safety and health. The Hospital agrees to co-operate reasonably in providing necessary information to enable the Committee its functions. Meetings shall be held every second month or more frequently at the call of the Chair if required. The Committee shall maintain minutes of meetings and make the Same available for review. Any representative appointed or accordancewith hereof shall serve for a term of one (1) calendar year from the date of appointment which may be renewed for further of one (1) year. Time off for such to attend meetings of the Accident Prevention Health and Safety Committee in accordance with the foregoing shall be granted, and any attending such meetings during their regularly scheduled hours of work shall not lose regular as a result of such The Union agrees to endeavour to obtain the membership in the observation of all safety rules and practices. Safety Shoes The Hospital will provide sixty dollars ($60.00) annually effective April and eighty dollars ($80.00) effective April to each employee who is required by the Hospital, as delineated below, to wear safety footwear during the of his duties. The Hospital will require employees the following functions to wear appropriate Engineering Services; Grounds; Transport; (only where frequently working in storage areas). (as determined by the Hospital) heavy carts on a regular basis, e.g., linen carts, food wagons. ARTICLE BULLETIN BOARDS The Employer shall provide bulletin that all employees will have access to them have the right to post notices of meetings and such other notices as may be of interest to the membership. The wage increase listed on a retroactive to contact,in writing (with a copy to the Union) at their last-known entitle who have left its employ, to advise them of their any retroactive wage adjustment. Any employees who have employees shall have notice from the Hospital in which to claim from the Hospital any adjustment to their remuneration entitlement. The retroactive payments shall be made by separate cheques to the employees so entitled within sixty (60) days from the date of ratification. All other adjustments shall be effective as set out specifically in this Collective Agreement.

  • Substance Abuse Testing The Parties agree that it is in the best interest of all concerned to promote a safe working environment. The Union has no objection to pre-employment substance abuse testing when required by the Employer and further, the Union has no objection to voluntary substance abuse testing to qualify for employment on projects when required by a project owner. The cost and scheduling of such testing shall be paid for and arranged by the Employer. The Union agrees to reimburse the Employer for any failed pre-access Alcohol and Drug test costs.

  • Substance Use Disorder counseling shall be provided by a QCC, or Chemical Dependency Counselor Intern. Substance use disorder education and life skills training shall be provided by counselors or individuals who have been trained in the education. All counselor interns shall work under the direct supervision of a QCC.

  • Infection Control Consistent with the Centers for Disease Control and Prevention Guideline for Infection Control in Health Care Personnel, and University Policy 3364-109-EH-603, the parties agree that all bargaining unit employees who come in contact with patients in the hospital or ambulatory care clinics will need to be vaccinated against influenza when flu season begins each fall. The influenza vaccine will be offered to all health care workers, including pregnant women, before the influenza season, unless otherwise medically contraindicated or it compromises sincerely held religious beliefs.

  • Anti-­‐Abuse Registry Operator may suspend, delete or otherwise make changes to domain names in compliance with its anti-­‐abuse policy.

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