Common use of Outside of California Clause in Contracts

Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible, including dental and orthodontic services that are an integral part of surgery for cleft palate proce- dures. Rehabilitative Services — Inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illness and Severe Emotional Disturbances of a Child, to restore an individual’s ability to function to the maximum extent practical. Rehabilitative Services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Residential Care — Mental Health or Substance Use Disorder Services provided in a facility or a free-standing residential treatment center that pro- vides overnight/extended-stay services for Mem- bers who do not require acute inpatient care. Respiratory Therapy — treatment, under the di- rection of a Physician and provided by a certified respiratory therapist, or other appropriately li- censed or certified Health Care Provider to pre- serve or improve a patient’s pulmonary function. Serious Emotional Disturbances of a Child —a minor under the age of 18 years who:

Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible, including dental and orthodontic services that are an integral part of surgery for cleft palate proce- dures. Rehabilitative Services Rehabilitation — Inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illness and Severe Emotional Disturbances of a Child, to restore an individual’s ability to function to the maximum extent practical. Rehabilitative Services Rehabilitation services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Residential Care — Mental Health or Substance Use Disorder Services provided in a facility or a free-standing residential treatment center that pro- vides overnight/extended-stay services for Mem- bers who do not require acute inpatient care. Respiratory Therapy — treatment, under the di- rection of a Physician and provided by a certified respiratory therapist, or other appropriately li- censed or certified Health Care Provider to pre- serve or improve a patient’s pulmonary function. Serious Emotional Disturbances of a Child —a minor under the age of 18 years who:

Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possiblepossi- ble, including dental and orthodontic services that are an integral part of surgery for cleft palate proce- durespro- cedures. Rehabilitative Services Rehabilitation — Inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illness and Severe Se- vere Emotional Disturbances of a Child, to restore re- store an individual’s ability to function to the maximum extent practical. Rehabilitative Services Rehabilitation ser- vices may consist of Physical Therapy, Occupational Occupa- tional Therapy, and/or Respiratory Therapy. Residential Care — Mental Health or Substance Use Disorder Abuse Services provided in a facility or a free-free- standing residential treatment center that pro- vides provides overnight/extended-stay services for Mem- bers Members who do not require acute inpatient care. Respiratory Therapy — treatment, under the di- rection direction of a Physician and provided by a certified certi- fied respiratory therapist, or other appropriately li- censed licensed or certified Health Care Provider to pre- serve or improve a patient’s pulmonary function. Routine Outpatient Mental Health and Sub- stance Abuse Services – professional (Physician) office visits for the diagnosis and treatment of Mental Health and Substance Abuse Conditions, including the individual, Family or group setting. Serious Emotional Disturbances of a Child —a minor under the age of 18 years who: