HOSPITAL SERVICES EXCLUDE THE FOLLOWING Sample Clauses

HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 8(a) above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs. d. All out-of-IPA Service Area expenses, except those elective Referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service area facility. e. Impatient and outpatient psychiatric care. f. Chemical dependency rehabilitation. g. Vision materials (lenses and frames) except for those surgically implanted as provided in paragraph 8(a) above. h. Anesthesiology services (inpatient and outpatient). i. Experimental procedures, including any type of procedure not generally recognized as of value by the medical community and its societies, as determined by PacifiCare in the reasonable exercise of its discretion and consultation with IPA. j. Cosmetic Surgery, except when performed to correct or repair the physical functioning of a body part as a result of a functional disorder or accidental injury. ATTACHMENT A2 MEDICAL SERVICES
Sample 1
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HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 10(a) above.
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 10(a) above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility. e. Vision materials (lenses and frames) except for those surgically implanted during cataract surgery. f. Anesthesiology services (inpatient and outpatient). g. Experimental procedures, including any type of procedure not generally recognized as of value by the medical community and its societies, as determined by PacifiCare and IPA, in conformance with state and federal law. h. Cosmetic Surgery, except when performed to correct or repair the physical functioning of a body part as a result of a functional disorder or accidental injury. i. Inpatient hospital care in excess of one hundred fifty (150) days per Subscriber per Year. j. Skilled nursing care in excess of one hundred (100) days per Subscriber per Year. ATTACHMENT A2 MEDICAL SERVICES
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraph 4 above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs, including immunosuppressive drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility.
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING. (a) Durable Medical Equipment (except as provided in Section 8 above); (b) Medical Services in the Service Area as defined by Exhibit L; (c) Outpatient prescription drugs (d) Vision materials (lenses and frames or contact lenses), except lenses surgically implanted during cataract surgery during outpatient surgery at a Hospital outpatient department or an ambulatory surgical center. (e) Emergent out-of-area hospital services. (f) Denied services
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 6 and 10(a) above. b. Medical Services in the IPA Service Area as defined by Attachment B hereto. c. Outpatient prescription drugs, including immunosuppressive drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility. e. Vision materials (lenses and frames) except for those surgically implanted during cataract surgery. f. Anesthesiology services (inpatient and outpatient). g. Experimental procedures, including any type of procedure not generally recognized as of value by the medical community and its societies, as determined by PacifiCare and IPA, in conformance with state and federal law. h. Cosmetic Surgery, except when performed to correct or repair the physical functioning of a body part as a result of a functional disorder or accidental injury. i. Inpatient hospital care in excess of one hundred fifty (150) days per Subscriber per Year except as provided in Paragraph 1 of this Attachment A. j. Skilled nursing care in excess of one hundred (100) days per Subscriber per Year. k. Respite Care AMENDMENT C SECURE HORIZONS MEDICAL AND HOSPITAL SUBSCRIBERS AGREEMENT Secure Horizons Medical and Hospital Subscriber Agreement is available upon request. A summary of the Schedule of Benefits is attached. EXHIBIT 4 ATTACHMENT E BENEFIT WITHHOLD INCENTIVE PROGRAM The purpose of the Benefit Withhold Incentive Program (BWIP) is to provide an incentive to the IPA to xxxxxx the efficient utilization of the Subscriber benefits outline in Attachment C, Section A "BENEFIT WITHHOLD", most particularly prescription drugs. The BWIP gives the IPA the ability to share in any savings when comparing actual utilization against the budgeted withhold amount. The budget will be set at [ ** ] of the monthly revenue received from HCFA for Subscribers who have designated IPA as their Participating Medical Group. Debited against this budget will be the actual expenses paid by PacifiCare for the earmarked benefits as outlined in Attachment C of those Subscribers who have designated IPA as their Participating Medical Group for the applicable month. The IPA will share [ ** ] of any savings in comparing the budget and actual expenses. PacifiCare shall provide, on a quarterly ba...
Sample 1
HOSPITAL SERVICES EXCLUDE THE FOLLOWING a. Durable Medical Equipment, except as provided in paragraphs 5 and 8(a) above. b. Medical Services in the IPA Service Area as defined by Attachment A2 hereto. c. Outpatient prescription drugs, including immunosuppressive drugs. d. All out-of-IPA Service Area expenses, except those elective referrals as authorized by IPA. PacifiCare, in conjunction with IPA, shall make all decisions regarding the duration of a Subscriber's care at the out-of-IPA Service Area facility and transfer of the Subscriber to an IPA Service Area facility. e. Vision materials (lenses and frames) except for those surgically implanted during cataract surgery.
Sample 1
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Related to HOSPITAL SERVICES EXCLUDE THE FOLLOWING

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Compliance Control Services (1) Support reporting to regulatory bodies and support financial statement preparation by making the Fund's accounting records available to the Trust, the Securities and Exchange Commission (the “SEC”), and the independent accountants.

  • Dental Services The following dental services are not covered, except as described under Dental Services in Section 3: • Dental injuries incurred as a result of biting or chewing. • General dental services including, but not limited to, extractions including full mouth extractions, prostheses, braces, operative restorations, fillings, frenectomies, medical or surgical treatment of dental caries, gingivitis, gingivectomy, impactions, periodontal surgery, non-surgical treatment of temporomandibular joint dysfunctions, including appliances or restorations necessary to increase vertical dimensions or to restore the occlusion. • Panorex x-rays or dental x-rays. • Orthodontic services, even if related to a covered surgery. • Dental appliances or devices. • Preparation of the mouth for dentures and dental or oral surgeries such as, but not limited to, the following: o apicoectomy, per tooth, first root; o alveolectomy including curettage of osteitis or sequestrectomy; o alveoloplasty, each quadrant; o complete surgical removal of inaccessible impacted mandibular tooth mesial surface; o excision of feberous tuberosities; o excision of hyperplastic alveolar mucosa, each quadrant; o operculectomy excision periocoronal tissues; o removal of partially bony impacted tooth; o removal of completely bony impacted tooth, with or without unusual surgical complications; o surgical removal of partial bony impaction; o surgical removal of impacted maxillary tooth; o surgical removal of residual tooth roots; and o vestibuloplasty with skin/mucosal graft and lowering the floor of the mouth. Dialysis Services • The following dialysis services received in your home: o installing or modifying of electric power, water and sanitary disposal or charges for these services; o moving expenses for relocating the machine; o installation expenses not necessary to operate the machine; and o training in the operation of the dialysis machine when the training in the operation of the dialysis machine is billed as a separate service. • Dialysis services received in a physician’s office.

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  • Hospital Services The Hospital will:

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18, 19, 20 and 21, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Special Aggregation Rule Applicable to Relationship Managers For purposes of determining the aggregate balance or value of accounts held by a person to determine whether an account is a High Value Account, a Reporting Financial Institution shall also be required, in the case of any accounts that a relationship manager knows or has reason to know are directly or indirectly owned, controlled, or established (other than in a fiduciary capacity) by the same person, to aggregate all such accounts.

  • Surgical Services All necessary procedures for extractions and other surgical procedures normally performed by a dentist.

  • Use of Verizon Telecommunications Services 2.1 Verizon Telecommunications Services may be purchased by Connectel under this Resale Attachment only for the purpose of resale by Connectel as a Telecommunications Carrier. Verizon Telecommunications Services to be purchased by Connectel for other purposes (including, but not limited to, Connectel’s own use) must be purchased by Connectel pursuant to other applicable Attachments to this Agreement (if any), or separate written agreements, including, but not limited to, applicable Verizon Tariffs.

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