Exceptions to Coverage. With respect to the exceptions, the following applies:
Exceptions to Coverage. Health Options has a process for allowing exceptions to our formulary. To obtain coverage consideration for a drug not on our formulary, you, your Designee, or the prescribing Provider must submit a request to Health Options’ PBM with a clinical rationale for the exception. Our PBM will make a decision within 48 hours, or in exigent circumstances, within 24 hours, upon receipt of all required information. Exigent circumstances exist when you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or when you are undergoing a current course of treatment using a non-formulary drug. SAMPLE In the case of exigent circumstances, if the request for coverage is approved, coverage for the drug will be available for the duration of the exigency. If the request for coverage is approved, the drug will be covered as a Tier 4 or Tier 5 drug (cost- sharing will apply as listed in the Schedule of Benefits), and the prescription will be considered a Covered Service. You, your Designee, or the prescribing Provider may request an accredited independent review organization review the denial of an exception request. If you or your Designee are requesting the exception, you will need to provide the prescribing Provider’s information so our PBM can contact the prescribing Provider to obtain information to support the request.
Exceptions to Coverage. Health Options has a process for allowing exceptions to our formulary. To obtain coverage consideration for a drug not on our formulary, you, your Designee, or the prescribing Provider must submit a request to Health Options’ PBM with a clinical rationale for the exception. Our PBM or Medical Benefit Manager (MBM) will make a decision within 48 hours, or in exigent circumstances, within 24 hours, upon receipt of all required information. Exigent circumstances exist when you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or when you are undergoing a current course of treatment using a non-formulary drug. A prescription that requires an exception for coverage shall be considered approved up to 30 calendar days if the exception process exceeds 48 hours from the receipt of all necessary information. In the case of exigent circumstances, if the request for coverage is approved, coverage for the drug will be available for the duration of the exigency. If the request for coverage is approved, the drug will be covered as a Tier 4 drug (cost-sharing will apply as listed in the Schedule of Benefits), and the prescription will be considered a Covered Service. You, your Designee, or the prescribing Provider may request an accredited independent review organization review the denial of an exception request. If you or your Designee are requesting the exception, you will need to provide the prescribing Provider’s information so our PBM can contact the prescribing Provider to obtain information to support the request.
Exceptions to Coverage. The following are excluded and not a part of this section: (i) any damage caused by an "Act of God" (earthquake, flood, acts of war, fire, lightning, wind or fire); (ii) gross or intentional damage caused by you to the inside wiring; (iii) damage to our Equipment (iv) any wiring you install; (v) repair or replacement of any of your equipment; (vi) repair or replacement of wires or jacks that we cannot access; (vii) any wiring issues that existed prior to the date we installed the Services at your premises; and (viii) problems occurring in any horizontal or vertical risers owned by another party. Television Privacy Policy As your service provider, we understand how important protecting your privacy is to you. The purpose of this policy statement is to explain how we treat your personally identifiable information. Generally, personally identifiable information is any information that identifies you individually. Aggregate non-individual information about a group of subscribers, which may include you, is not considered personally identifiable information. At all times our goal is to protect your personally identifiable information with care and respect for your privacy.
Exceptions to Coverage. Service under this Agreement is offered and valid only in the countries described in the Country Variation section, below.
Exceptions to Coverage. Service under this Agreement is offered and valid only to residents located in Australia. Service under this Agreement is not available where prohibited by law.
Exceptions to Coverage. Service under this Agreement is offered and valid only to residents located in Canada. Service under this Agreement is not available where prohibited by law.
Exceptions to Coverage. Service under this Agreement is offered and valid only to residents located in New Zealand. Service under this Agreement is not available where prohibited by law.
Exceptions to Coverage. Service under this Agreement is offered and valid only to residents located in the fifty states of the United States of America and the District of Columbia. Service under this Agreement is not available where prohibited by law.
Exceptions to Coverage. Health Options has a process for allow ing exceptions to our formulary. To obtain coverage consideration for a drug not on our formulary, you, your Designee, or the prescribing Provider must submit a request to a decision within 48 hours, or in exigent circumstances, within 24 hours, upon receipt of all required information. Exigent circumstances exist when you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or when you are undergoing a current course of treatment using a non - formulary drug. In the case of exigent circumstances, if the request for coverage is approved, coverage for the drug will be available for the duration of the ex igency. If the request for coverage is approved, the drug will be covered as a Tier 4 or Tier 5 drug (cost - sharing will apply as listed in the Schedule of Benefits ), and the prescription will be considered a Covered Service. You, your Designee, or the pre scribing Provider may request an accredited independent review organization review the denial of an exception request. If you or your Designee are requesting the tact the prescribing Provider to obtain information to support the request.
