Preventive Care. This plan covers preventive care as described below. “
Preventive Care. Drugs to treat infertility, to enhance fertility or to treat sexual dysfunction Weight management drugs or drugs for the treatment of obesity Replacement of lost or stolen medication
Preventive Care. Group shall have sole responsibility for --------------- all preventive care intended to delay, or intercept the development of pathologic conditions.
Preventive Care. Preventive care means: Evidence based items or services that are rated “A” or “B” in the current recommendations of the United States Preventive Services task Force with respect to the Member; Immunizations for routine use for Members of all ages as recommended by the Advisory Committee on Immunization Practices of the Centers of Disease Control and Prevention with respect to the Member; Evidence–informed preventive care and screenings for Members who are infants, children and adolescents, as included in the comprehensive guidelines supported by the Health Resources and Services Administration; Evidence–informed preventive care and screenings for Members as included in the comprehensive guidelines supported by the Health Resources and Services Administration; and Any other evidence-based or evidence-informed items as determined by federal and/or state law. Examples of preventive care include, but are not limited to: routine physical examinations, including related laboratory tests and x-rays, immunizations and vaccines, well baby care, pap smears, mammography, screening tests, bone density tests, colorectal cancer screening, prostate cancer screening, and Nicotine Dependence Treatment.
Preventive Care. To the extent required by PPACA, preventive care (with no cost-sharing) when preventive care is provided by Participating Providers.
Preventive Care. The Plan does not provide Benefits for preventive care and well-care services, unless otherwise stated in this Agreement in Sections 4.B and 2.
Preventive Care. Pediatric No Copay No Copay No Copay Deductible Waived-No Copay Age based schedule 7 exams Birth to One 7 exams Birth to One 7 exams Birth to One 7 exams Birth to One 7 exams 1-5 years 7 exams 1-5 years 7 exams 1-5 years 7 exams 1-5 years 5 -22 years-Preventative exams allowed once a year 5 -22 years-Preventative exams allowed once a year 5 -22 years-Preventative exams allowed once a year 5 -22 years-Preventative exams allowed once a year Adult No Copay No Copay No Copay Deductible Waived-No Copay Age Based Schedule 22 and over-Preventative exams allowed once a year 22 and over-Preventative exams allowed once a year 22 and over-Preventative exams allowed once a year 22 and over- Preventative exams allowed once a year Immunizations As part of Preventative Exam As part of Preventative Exam As part of Preventative Exam As part of Preventative Exam Gynelogical/Obstetrics $0 Copay for annual exam $0 Copay for annual exam $0 Copay for annual exam Deductible waived-$0 Copay for annual exam $25 Copay Maternity-First Visit Only $25 Copay Maternity-First Visit Only $20 Copay Maternity-First Visit Only After deductable 80% In Network Mammography Age 35-39 Base Line Screening Age 35-39 Base Line Screening Age 35-39 Base Line Screening Age 35-39 Base Line Screening 40 and over once a year 40 and over once a year 40 and over once a year 40 and over once a year (Add'l Exams Available if Recommended by Doctor) (Add'l Exams Available if Recommended by Doctor) (Add'l Exams Available if Recommended by Doctor) (Add'l Exams Available if Recommended by Doctor) Hearing No Copay (once every 2 calendar years) No Copay (once every 2 calendar years) $0 Copay (once a every 2 years) No Copay (once every 2 calendar years) Deductible Waived Vision No Copay (once every 2 calendar years) No Copay (once every 2 calendar years) $0 Copay (once a every 2 years) No Copay (once every 2 calendar years) Deductible Waived MEDICAL SERVICES Medical office visits $15 Copay PCP $15 Copay PCP $20 Copay After Deductible 80% Co-Insurance in $25 Specialist $25 Specialist Unlimited Visits network 60% Out of Network Physical or Occupational $25 Copay $25 Copay $20 Copay After Deductible 80% Co-Insurance in network 60% out of network Therapy 30 Combined Visits for pt, ot st per member per year 30 Combined Visits for pt, ot st per member per year 30 Combined Visits for pt, ot st per member per year 60 Combined Visits for pt, ot st per member per year 20 visit for chiro-prior auth is required on pt/ot 20 visit...
Preventive Care. Preventive care means care and services to avert disease/illness and/or its consequences. There are three (3) levels of preventive care: 1) primary, such as immunizations, aimed at preventing disease; 2) secondary, such as disease screening programs aimed at early detection of disease; and 3) tertiary, such as physical therapy, aimed at restoring function after the disease has occurred. Commonly, the term "preventive care" is used to designate prevention and early detection programs rather than restorative programs. The following preventive services are also included in the managed care Benefit Package. These preventive services are essential for promoting wellness and preventing illness. MCOs must offer the following: - General health education classes. - Pneumonia and influenza immunizations for at risk populations. - Smoking cessation classes, with targeted outreach for adolescents and pregnant women. - Childbirth education classes. - Parenting classes covering topics such as bathing, feeding, injury prevention, sleeping, illness prevention, steps to follow in an emergency, growth and development, discipline, signs of illness, etc.
Preventive Care. Preventive Care services include outpatient services and office services. Screenings and other services are covered as Preventive Care for adults and children with no current symptoms or prior history of a medical condition associated with that screening or service. Members who have current symptoms or have been diagnosed with a medical condition are not considered to require preventive care for that condition but instead benefits will be considered under the diagnostic services benefit. In-Network Preventive care services in this section shall meet requirements as determined by federal and state law. Many preventive care services are covered by your policy with no Deductible, Copayments or Coinsurance from the Member when provided by an In-Network Provider. That means Alliant pays 100% of the allowed amount. These services fall under four broad categories as shown below:
Preventive Care. Routine Well Adult Care 100% 50% after deductible Includes: office visits, pap smear, mammogram, gynecological exam, routine physical examination, x-rays, laboratory tests, prostate specific antigen test, colonoscopies, sigmoidoscopies and anoscopy, proctosigmoidoscopy, medical tests and other preventive services as required by law. Routine Well Child Care 100% 50% after deductible Includes: office visits, routine physical examination, laboratory tests, x-rays, immunizations, and other Preventive services as required by law. Flu Shot 100% Paid Same As Network Eye Exam (including refractive exams) 100% after deductible Limited to 1 per Calendar Year, unless otherwise required by law Not Covered Organ Transplants 100% after deductible Not Covered Prescription Drugs (Mail Order or Retail Pharmacy) 100% after deductible Paid Same As Network Other Medical Services and Supplies 100% after deductible 80% after deductible Drugs and Products included on the Select Drugs and Products List Require pre-certification and enrollment in the Select Drugs and Products Program Products included on the Plan Select Drugs and Products List require prior authorization and enrollment in the Select Drugs and Products Program. MEDICAL BENEFITS SCHEDULE MINIMUM VALUE PLAN NETWORK PROVIDERS NON-NETWORK PROVIDERS Note: The maximums listed below are the total for Network and Non-Network expenses. For example, if a maximum of 60 days is listed twice under a service, the Calendar Year maximum is 60 days total which may be split between Network and Non-Network providers. DEDUCTIBLE, PER CALENDAR YEAR Per Covered Person $5,000 $10,000 Per Family Unit $10,000 $20,000 The Network Deductible amounts will be combined with the Non-Network Deductible amounts. The Calendar Year deductible is waived for the following Covered Charges: - Network Preventive Care MAXIMUM OUT-OF-POCKET AMOUNT, PER CALENDAR YEAR (including deductibles) Per Covered Person $6,500 $13,000 Per Family Unit $13,000 $26,000 The Network Out-of-Pocket amounts will be combined with the Non-Network Out-of-Pocket amounts. The Plan will pay the designated percentage of Covered Charges until out-of-pocket amounts are reached, at which time the Plan will pay 100% of the remainder of Covered Charges for the rest of the Calendar Year unless stated otherwise. The following charges do not apply toward the out-of-pocket maximum: Non-Precertification penalties Amounts over Usual and Reasonable Charges Amounts for products included on the S...
