Complications of Pregnancy. Health Care Services provided to you for the treatment of complications of pregnancy are Covered Services and will be treated the same as any other medical Condition. Complications of pregnancy include:
Complications of Pregnancy. Covered Services for Complications of Pregnancy will be the same as for treatment of any other physical illness and may require Preauthorization. Family Planning. Covered Services, which may require Preauthorization, include:
Complications of Pregnancy. Physical effects directly caused by pregnancy but which are not considered from a medical viewpoint to be the effect of normal pregnancy, including conditions related to ectopic pregnancy or those that require cesarean section.
Complications of Pregnancy. 6. Hospital stays for other medically necessary reasons associated with maternity care.
Complications of Pregnancy. Benefits are provided for complications of pregnancy resulting from conditions requiring Hospital confinement when the pregnancy is not terminated and whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy. Benefits for a normal or difficult delivery are not covered under this provision. Such benefits are determined solely by the Maternity Care section of this Contract. In-network and out-of-network cost-sharing apply accordingly. CONSULTATION SERVICES Covered when the special skill and knowledge of a consulting Physician is required for the diagnosis or treatment of an illness or Injury. DIABETES We cover Medically Necessary equipment, supplies, pharmacological agents, and outpatient self-management training and education, including nutritional therapy for individuals with insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin-using diabetes as prescribed by the Physician. Covered Services for outpatient self-management training and education must be provided by a certified, registered or licensed health care professional with expertise in diabetes.
Complications of Pregnancy. Complications of Pregnancy result from conditions requiring Hospital confinement when the pregnancy is not terminated. The diagnoses of the complications are distinct from pregnancy but adversely affected or caused by pregnancy. Such conditions include acute nephritis, nephrosis, cardiac decompensation, missed or threatened abortion, preeclampsia, intrauterine fetal growth retardation and similar medical and surgical conditions of comparable severity. An ectopic pregnancy which is terminated is also considered a Complication of Pregnancy. Complications of Pregnancy shall not include false labor, cesarean section, occasional spotting, and Physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum and similar conditions associated with the management of a difficult pregnancy which are not diagnosed distinctly as Complications of Pregnancy. Congenital/developmental Anomaly A condition or conditions that are present at birth regardless of causation. Such conditions may be hereditary or due to some influence during gestation.
Complications of Pregnancy. In the event of complications arising out of pregnancy such that the employee is unable to return to work at the expiry of an approved leave of absence, she will receive payment of normal salary from accumulated sick leave benefits, upon submission of written medical documentation.
Complications of Pregnancy. Acute nephritis, nephrosis, cardiac decompensation, missed abortion, spontaneous abortion, missed miscarriage, ectopic pregnancy, puerperal infection, pre-eclampsia, eclampsia, toxemia, or hydatidiform mole. It also includes a condition whose diagnosis is distinct from pregnancy but is adversely affected or caused by pregnancy, and which requires confinement or surgery prior to the full term of pregnancy to avoid the threat of permanent damage to the life or health of the mother. C
Complications of Pregnancy. MATERNITY, AND BIRTH (Except for Plans 4, 5 and 6): Maternity complications and/or newborn complications of birth (not related to congenital or hereditary disorders), such as prematurity, low birth weight, jaundice, hypoglycemia, respira- tory distress, and birth trauma are covered as follows:
Complications of Pregnancy. Benefits are provided for complications of pregnancy resulting from conditions requiring Hospital confinement when the pregnancy is not terminated and whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or arecaused by pregnancy. Benefits for a normal or difficult delivery are not covered under this provision. Such benefits are determined solely by the Maternity Care section of this Contract. In-network and out-of-network cost-sharing apply accordingly. CONSULTATION SERVICES Covered when the special skill and knowledge of a consulting Physician is required for the diagnosis or treatment of an illness or Injury. DIABETES We cover Medically Necessary equipment, supplies, pharmacological agents, and outpatient self-management training and education, including nutritional therapy for individuals with insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin-using diabetes as prescribed by the Physician. Covered Services for outpatient self-management training and education must be provided by a certified, registered or licensed health care professional with expertise in diabetes. DIALYSIS TREATMENT Dialysis treatment is a Covered Service. DURABLE MEDICAL EQUIPMENT Your plan will pay the rental charge up to the lesser of the purchase price of the equipment or twelve (12) months of rental charges. In addition to meeting criteria for Medical Necessity, the equipment must also be used to improve the functions of a malformed part of the body or to prevent or slow further decline of the Member’s medical condition. The equipment must beordered and/or prescribed by a Physician and be appropriate for in-home use. The equipment must meet the following criteria: • It can stand repeated use; • It is manufactured solely to serve a medical purpose; • It is not merely for comfort or convenience; • It is normally not useful to a person not ill or injured; • It is ordered by a Provider; • The Provider certifies in writing the Medical Necessity for the equipment. o The Provider also states the length of time the equipment will be required; o We may require proof at any time of the continuing Medical Necessity of any item; o It is related to the patient’s physical disorder. EMERGENCY ROOM SERVICES/EMERGENCY MEDICAL SERVICES Coverage is provided for Hospital emergency room care for initial services rendered for the onset of symptoms for an emergency medical condition or serious Accidental Injury which requires immedi...
