Common use of Donor services Clause in Contracts

Donor services. Transplant Benefits include coverage for donation-related services for a living donor, including a potential donor, or a transplant organ bank. Donor services must be directly related to a covered transplant for a Member of this plan. Donor services include:  Donor evaluation;  Harvesting of the organ, tissue, or bone marrow; and  Treatment of medical complications for 90 days after the evaluation or harvest procedure. Urgent care services Benefits are available for urgent care services you receive at an urgent care center or during an after-hours office visit. You can access urgent care instead of going to the emergency room if you have a medical condition that is not life-threatening but prompt care is needed to prevent serious deterioration of your health. If you need to visit an urgent care center and you are in your Medical Group Service Area, go to the urgent care center designated by your Medical Group or call your PCP. If you are outside of your Medical Group Service Area but within California and need urgent care, you may visit any urgent care center near you. See the Out-of-area services section for information on urgent care services outside California. Exclusions and limitations This section describes the general exclusions and limitations that apply to all your plan Benefits. General exclusions and limitations 1 This plan only covers services that are Medically Necessary. A Physician or other Health Care Provider’s decision to prescribe, order, recommend, or approve a service or supply does not, in itself, make it Medically Necessary. 2 Routine physical examinations solely for:  Immunizations and vaccinations, by any mode of administration, for the purpose of travel; or  Licensure, employment, insurance, court order, parole, or probation. This exclusion does not apply to Medically Necessary services that Blue Shield is required by law to cover for Severe Mental Illnesses or Serious Emotional Disturbances of a Child. 3 Hospitalization solely for X-ray, laboratory or any other outpatient diagnostic studies, or for medical observation. 4 Routine foot care items and services that are not Medically Necessary, including:  Callus treatment;  Corn paring or excision;  Toenail trimming;  Over-the-counter shoe inserts or arch supports; or  Any type of massage procedure on the foot. This exclusion does not apply to items or services provided through a Participating Hospice Agency or covered under the diabetes care Benefit. 5 Home services, hospitalization, or confinement in a health facility primarily for rest, custodial care, or domiciliary care. Custodial care is assistance with Activities of Daily Living furnished in the home primarily for supervisory care or supportive services, or in a facility primarily to provide room and board. Domiciliary care is a supervised living arrangement in a home-like environment for adults who are unable to live alone because of age-related impairments or physical, mental, or visual disabilities.

Donor services. Transplant Benefits include coverage for donation-related services for a living donor, including a potential donor, or a transplant organ bank. Donor services must be directly related to a covered transplant for a Member of this plan. Donor services include:  • Donor evaluation;  • Harvesting of the organ, tissue, or bone marrow; and  • Treatment of medical complications for 90 days after the evaluation or harvest procedure. Urgent care services Benefits are available for urgent care services you receive at an urgent care center or during an after-hours office visit. You can access urgent care instead of going to the emergency room if you have a medical condition that is not life-threatening but prompt care is needed to prevent serious deterioration of your health. If you need to visit an urgent care center and you are in your Medical Group Service Area, go to the urgent care center designated by your Medical Group or call your PCP. If you are outside of your Medical Group Service Area but within California and need urgent care, you may visit any urgent care center near you. See the Out-of-area services section for information on urgent care services outside California. Exclusions and limitations This section describes the general exclusions and limitations that apply to all your plan Benefits. Prescription Drug Benefits have additional exclusions and limitations. General exclusions and limitations 1 This plan only covers services that are Medically Necessary. A Physician or other Health Care Provider’s decision to prescribe, order, recommend, or approve a service or supply does not, in itself, make it Medically Necessary. 2 Routine physical examinations solely for:  • Immunizations and vaccinations, by any mode of administration, for the purpose of travel; or  • Licensure, employment, insurance, court order, parole, or probation. This exclusion does not apply to Medically Necessary services that Blue Shield is required by law to cover for Severe Mental Illnesses or Serious Emotional Disturbances of a Child. 3 Hospitalization solely for X-ray, laboratory or any other outpatient diagnostic studies, or for medical observation. 4 Routine foot care items and services that are not Medically Necessary, including:  • Callus treatment;  • Corn paring or excision;  • Toenail trimming;  • Over-the-counter shoe inserts or arch supports; or  • Any type of massage procedure on the foot. This exclusion does not apply to items or services provided through a Participating Hospice Agency or covered under the diabetes care Benefit. 5 Home services, hospitalization, or confinement in a health facility primarily for rest, custodial care, or domiciliary care. Custodial care is assistance with Activities of Daily Living furnished in the home primarily for supervisory care or supportive services, or in a facility primarily to provide room and board. Domiciliary care is a supervised living arrangement in a home-like environment for adults who are unable to live alone because of age-related impairments or physical, mental, or visual disabilities.

Donor services. Transplant Benefits include coverage for donation-related services for a living donor, including a potential donor, or a transplant organ bank. Donor services must be directly related to a covered transplant for a Member of this plan. Donor services include:  Donor evaluation;  Harvesting of the organ, tissue, or bone marrow; and  Treatment of medical complications for 90 days after the evaluation or harvest procedure. Urgent care services Benefits are available for urgent care services you receive at an urgent care center or during an after-hours office visit. You can access urgent care instead of going to the emergency room if you have a medical condition that is not life-threatening but prompt care is needed to prevent serious deterioration of your health. If you need to visit an urgent care center and you are in your Medical Group Service Area, go to the urgent care center designated by your Medical Group or call your PCP. If you are outside of your Medical Group Service Area but within California and need urgent care, you may visit any urgent care center near you. See the Out-of-area services section for information on urgent care services outside California. Exclusions and limitations This section describes the general exclusions and limitations that apply to all your plan Benefits. Prescription Drug Benefits have additional exclusions and limitations. General exclusions and limitations 1 This plan only covers services that are Medically Necessary. A Physician or other Health Care Provider’s decision to prescribe, order, recommend, or approve a service or supply does not, in itself, make it Medically Necessary. 2 Routine physical examinations solely for:  Immunizations and vaccinations, by any mode of administration, for the purpose of travel; or  Licensure, employment, insurance, court order, parole, or probation. This exclusion does not apply to Medically Necessary services that Blue Shield is required by law to cover for Severe Mental Illnesses or Serious Emotional Disturbances of a Child. 3 Hospitalization solely for X-ray, laboratory or any other outpatient diagnostic studies, or for medical observation. 4 Routine foot care items and services that are not Medically Necessary, including:  Callus treatment;  Corn paring or excision;  Toenail trimming;  Over-the-counter shoe inserts or arch supports; or  Any type of massage procedure on the foot. This exclusion does not apply to items or services provided through a Participating Hospice Agency or covered under the diabetes care Benefit. 5 Home services, hospitalization, or confinement in a health facility primarily for rest, custodial care, or domiciliary care. Custodial care is assistance with Activities of Daily Living furnished in the home primarily for supervisory care or supportive services, or in a facility primarily to provide room and board. Domiciliary care is a supervised living arrangement in a home-like environment for adults who are unable to live alone because of age-related impairments or physical, mental, or visual disabilities.

Donor services. Transplant Benefits include coverage for donation-related services for a living donor, including a potential donor, or a transplant organ bank. Donor services must be directly related to a covered transplant for a Member of this plan. Donor services include:  Donor evaluation;  Harvesting of the organ, tissue, or bone marrow; and  Treatment of medical complications for 90 days after the evaluation or harvest procedure. Urgent care services Benefits are available for urgent care services you receive at an urgent care center or during an after-hours office visit. You can access urgent care instead of going to the emergency room if you have a medical condition that is not life-threatening but prompt care is needed to prevent serious deterioration of your health. If you need to visit an urgent care center and you are in your Medical Group Service Area, go to the urgent care center designated by your Medical Group or call your PCP. If you are outside of your Medical Group Service Area but within California and need urgent care, you may visit any urgent care center near you. See the Out-of-area services section for information on urgent care services outside California. Exclusions and limitations This section describes the general exclusions and limitations that apply to all your plan Benefits. General exclusions and limitations 1 This plan only covers services that are Medically Necessary. A Physician or other Health Care Provider’s decision to prescribe, order, recommend, or approve a service or supply does not, in itself, make it Medically Necessary. 2 Routine physical examinations solely for:  Immunizations and vaccinations, by any mode of administration, for the purpose of travel; or  Licensure, employment, insurance, court order, parole, or probation. This exclusion does not apply to Medically Necessary services that Blue Shield is required by law to cover for Severe Mental Illnesses or Serious Emotional Disturbances of a Child. 3 Hospitalization solely for X-ray, laboratory or any other outpatient diagnostic studies, or for medical observation. 4 Routine foot care items and services that are not Medically Necessary, including:  Callus treatment;  Corn paring or excision;  Toenail trimming;  Over-the-counter shoe inserts or arch supports; or  Any type of massage procedure on the foot. This exclusion does not apply to items or services provided through a Participating Hospice Agency or covered under the diabetes care Benefit. 5 Home services, hospitalization, or confinement in a health facility primarily for rest, custodial care, or domiciliary care. Custodial care is assistance with Activities of Daily Living furnished in the home primarily for supervisory care or supportive services, or in a facility primarily to provide room and board. Domiciliary care is a supervised living arrangement in a home-like environment for adults who are unable to live alone because of age-related impairments or physical, mental, or visual disabilities.

Donor services. Transplant Benefits include coverage for donation-related services for a living donor, including a potential donor, or a transplant organ bank. Donor services must be directly related to a covered transplant for a Member of this plan. Donor services include:  • Donor evaluation;  • Harvesting of the organ, tissue, or bone marrow; and  • Treatment of medical complications for 90 days after the evaluation or harvest procedure. Urgent care services Benefits are available for urgent care services you receive at an urgent care center or during an after-hours office visit. You can access urgent care instead of going to the emergency room if you have a medical condition that is not life-threatening but prompt care is needed to prevent serious deterioration of your health. If you need to visit an urgent care center and you are in your Medical Group Service Area, go to the urgent care center designated by your Medical Group or call your PCP. If you are outside of your Medical Group Service Area but within California and need urgent care, you may visit any urgent care center near you. See the Out-of-area services section for information on urgent care services outside California. Exclusions and limitations This section describes the general exclusions and limitations that apply to all your plan Benefits. General exclusions and limitations 1 This plan only covers services that are Medically Necessary. A Physician or other Health Care Provider’s decision to prescribe, order, recommend, or approve a service or supply does not, in itself, make it Medically Necessary. 2 Routine physical examinations solely for:  • Immunizations and vaccinations, by any mode of administration, for the purpose of travel; or  • Licensure, employment, insurance, court order, parole, or probation. This exclusion does not apply to Medically Necessary services that Blue Shield is required by law to cover for Severe Mental Illnesses or Serious Emotional Disturbances of a Child. 3 Hospitalization solely for X-ray, laboratory or any other outpatient diagnostic studies, or for medical observation. 4 Routine foot care items and services that are not Medically Necessary, including:  • Callus treatment;  • Corn paring or excision;  • Toenail trimming;  • Over-the-counter shoe inserts or arch supports; or  • Any type of massage procedure on the foot. This exclusion does not apply to items or services provided through a Participating Hospice Agency or covered under the diabetes care Benefit. 5 Home services, hospitalization, or confinement in a health facility primarily for rest, custodial care, or domiciliary care. Custodial care is assistance with Activities of Daily Living furnished in the home primarily for supervisory care or supportive services, or in a facility primarily to provide room and board. Domiciliary care is a supervised living arrangement in a home-like environment for adults who are unable to live alone because of age-related impairments or physical, mental, or visual disabilities.