Fertility Services Clause Samples

Fertility Services. Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the Advantage Plan’s service area. If these individuals use a provider within the plan administrator’s national network, services will be covered at Benefit Level Two. If a national network provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If a national network provider is available but not used, benefits will be covered at Benefit Level Three. All terms and conditions outlined in the Summary of Benefits will apply.

Fertility Services. The plan provides Benefits for fertility diagnostic care, fertility treatment and for fertility preservation services that are consistent with the guidelines published by the American Society for Reproductive Medicine. Nonmedical expenses related to fertility and experimental fertility procedures are not covered. For additional information on services covered, contact Member Services.

Fertility Services. This benefit has one or more exclusions as specified in the Exclusions Section. Male vasectomies are covered except for under high-deductible individual or group health plans until an insured’s deductible has been met. Tubal ligation/sterilization is a covered benefit. This benefit has one or more exclusions as specified in the Exclusions Section. Coverage is provided for diagnosing, monitoring, and controlling of disorders of Genetic Inborn Errors of Metabolism (IEM) where there are standard methods of treatment, when Medically Necessary and subject to the Limitations, Exclusions, and Prior Authorization requirements listed in this Agreement. Coverage for the treatment of genetic inborn errors of metabolism are provided with the same Durational limits, caps, deductibles, coinsurance and copayments as any other illnesses. Medical services provided by licensed Healthcare Professionals, including Practitioners/Providers, dieticians and nutritionists with specific training in managing Members diagnosed with IEM are Covered. Covered Services include: • Nutritional and medical assessment. • Newborn Screening for Metabolic Diseases. • Clinical services. • Biochemical analysis. • Medical supplies. • Prescription Drugs/Medications – refer to Prescription Drugs/Medications Section. • Corrective lenses for conditions related to Genetic Inborn Errors of Metabolism. • Nutritional management. • Special Medical Foods are dietary items that are specially processed and prepared to use in the treatment of Genetic Inborn Errors of Metabolism to compensate for the metabolic abnormality and to maintain adequate nutritional status when we approve the Prior Authorization request and when provided under the on-going direction of a qualified and licensed healthcare Practitioner/Provider team. Special medical foods may be prescribed for other medically necessary conditions. This does not include coverage of nutritional items/food supplements that are available over-the counter and/or without prescription. • One pair of standard (non-tinted) eyeglasses (or contact lenses if Medically Necessary) is Covered within 12 months after cataract surgery or when related to Genetic Inborn Error of Metabolism. This includes the Eye Refraction examination, lenses and standard frames. Refer to your Summary of Benefits and Coverage for applicable Cost-Sharing amounts (office visit Copayments, Inpatient Hospital, outpatient facility, Prescription Drug/Medications and other related Deductibles, Coi...

Fertility Services. Expansion of Out of Network Care Beyond Point of Services

Fertility Services h. Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the Advantage Plan’s service areas of the health plans participating in Advantage. If these individuals use the plana provider within the plan administrator’s national preferred provider organization in their areanetwork, services will be covered at Benefit Level Two. If a national preferrednetwork provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If thea national preferrednetwork provider organization is available but not used, benefits will be paid at the POS level described in paragraph “i” below. All terms and conditions outlined in the Summary of Benefits will applycovered at Benefit Level Three.