Abortion Services. If you purchased this plan through HSRI and this plan provides coverage for abortion services for which federal payment is prohibited under existing guidelines, a portion of each premium payment is set aside to pay for those services. We collect $1 per member per month in each premium payment, and deposit the collected funds into a separate account. This account keeps the collected amounts separate from funds used to pay for all other healthcare covered services. We use only these funds to pay for the costs of those abortion services for which federal payment is prohibited.
Abortion Services. Abortions for a pregnancy which, as certified by a Physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed are covered. Behavioral Health Services Benefits and coverage for behavioral health services are provided under the same terms and conditions applicable to this plan’s medical and surgical benefits and coverage. Outpatient Mental Health Care. Covered Services include diagnostic evaluation and treatment or crisis intervention when authorized by HMO or its designated behavioral health administrator. Inpatient Mental Health Care. Covered Services include inpatient Mental Health Care when authorized by HMO or its designated behavioral health administrator. Covered Services must be rendered based on an individual treatment plan with specific attainable goals and objectives appropriate to both the patient and the treatment modality of the program. Services in a Residential Treatment Center for Children and Adolescents, a Residential Treatment Center or a Crisis Stabilization Unit are available only when the Member has an acute condition that substantially impairs thought, perception of reality, emotional process or judgment, or grossly impairs behavior as manifested by recent disturbed behavior, which would otherwise necessitate confinement in a Participating Mental Health Treatment Facility.
Abortion Services. We do not provide benefits for procedures, equipment, services, supplies, or charges for abortions for which Federal funding is prohibited. Federal funding is allowed for abortions, where a pregnancy is the result of rape or incest, or for a pregnancy which, as certified by a physician, places the woman in danger of death unless an abortion is performed.
Abortion Services. This plan covers abortion services in the case of rape or incest, or for a pregnancy which places the woman in danger of death unless an abortion is performed (i.e., abortions for which federal funding is allowed). Preauthorization may be required.
Abortion Services. We cover abortions in the case of rape or incest, or for a pregnancy which places the woman in danger of death unless an abortion is performed (i.e., abortions for which federal funding is allowed). Prior authorization is recommended.
Abortion Services. Abortions for a pregnancy which, as certified by a Physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed are covered. Behavioral Health Services Outpatient Mental Health Care. Covered Services include diagnostic evaluation and treatment or crisis intervention when authorized by HMO or its designated behavioral health administrator. Inpatient Mental Health Care. Covered Services include inpatient Mental Health Care when authorized by HMO or its designated behavioral health administrator. Covered Services must be rendered based on an individual treatment plan with specific attainable goals and objectives appropriate to both the patient and the treatment modality of the program. Services in a Residential Treatment Center for Children and Adolescents, a Residential Treatment Center or a Crisis Stabilization Unit are available only when the Member has an acute condition that substantially impairs thought, perception of reality, emotional process or judgment, or grossly impairs behavior as manifested by recent disturbed behavior, which would otherwise necessitate confinement in a Participating Mental Health Treatment Facility.
Abortion Services. The Contractor shall provide Medically Necessary Abortion Services and EOHHS shall pay a capitated rate for Medically Necessary Abortion Services for the Contractor’s Enrollees. Notwithstanding any provision to the contrary, the Contractor shall provide Medically Necessary Abortion Services in accordance with all applicable requirements of Exhibit 1, which is incorporated by reference herein, and as further set forth in this Contract. Medically Necessary Abortion Services provided under this Contract shall be limited to the codes listed in Exhibit 3 attached hereto. Codes for other Medically Necessary Covered Services shall be provided for in accordance with Exhibit 1. Abortion Services include, in addition to the medication or surgical abortion itself, pre-operative evaluation and examination; pre-operative counseling; laboratory services, including pregnancy testing, blood type, and Rh factor; Rh(d) immune globulin (human); anesthesia (general or local); echography; and post-operative (follow-up) care. The Contractor shall pay for Abortion Services at or above the rates specified in 101 CMR 313.00 and the Physician Manual for MassHealth Providers, as applicable. Abortion Services Payment and Reconciliation Process for Enrollees For each Contract Year (CY), EOHHS shall pay the Contractor a capitation rate for providing Medically Necessary Abortion Services for the Contractor’s Enrollees as follows: The Contractor shall timely process and pay its Network Providers’ claims for all authorized Medically Necessary Abortion Services, as defined in Subsection 1.B, above; EOHHS shall estimate its annual payment liability to the Contractor for Abortion Services as follows: (1) multiply the monthly capitation rate for each Rating Category as set forth in Exhibit 2 attached hereto, by the projected number of monthly Enrollees in that Rating Category; (2) sum the subtotals for each Rating Category; and (3) multiply that result by the number of months in the CY;
Abortion Services. 3. Outpatient rehabilitation services Physical therapy, Occupational therapy, and Speech therapy for non-chronic conditions and acute illnesses and injuries. Limited to treatment for a 60-day (that is, 60 business days) consecutive period per incident of illness of injury, beginning with the first day of treatment per contract year. Speech therapy services rendered for treatment delays in speech development, unless resulting from disease, injury, or congenital defects are not covered.-
Abortion Services. A. The Contractor shall provide Medically Necessary Abortion Services and EOHHS shall pay a capitated rate for Medically Necessary Abortion Services for the Contractor’s Enrollees. Notwithstanding any provision to the contrary, the Contractor shall provide Medically Necessary Abortion Services in accordance with all applicable requirements of Exhibit 1, which is incorporated by reference herein, and as further set forth in this Contract. Medically Necessary Abortion Services provided under this Contract shall be limited to the codes listed in Exhibit 3 attached hereto. Codes for other Medically Necessary Covered Services shall be provided for in accordance with Exhibit 1. Abortion Services include, in addition to the medication or surgical abortion itself, pre-operative evaluation and examination; pre-operative counseling; laboratory services, including pregnancy testing, blood type, and Rh factor; Rh(d) immune globulin (human); anesthesia (general or local); echography; and post-operative (follow-up) care.
Abortion Services
