Ineligible Charges Clause Samples
Ineligible Charges. Charges for health care services that are not Covered Services because the services are not Medically Necessary or Prior Authorization was not obtained. Such charges are not eligible for payment. A facility which does not meet the minimum requirements to become an In-Network Hospital. Services rendered to a Member by such a Hospital are not eligible for payment. A Provider which does not meet the minimum requirements to become an In- Network Provider or does not otherwise meet the requirements to contract with Alliant. Services rendered to a Member by such a Provider are not eligible for payment. The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of one year of frequent, unprotected heterosexual vaginal intercourse. This does not include conditions for men when the cause is a vasectomy or orchiectomy or for women when the cause is tubal ligation or hysterectomy. Bodily harm from a non-occupational accident. Covered Services provided to Members by their Physician through In-Network Hospital and In-Network Providers. A Hospital which is a party to a written agreement with, and in a form approved by, Alliant to provide services to its Members. A Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, who is in the managed network for this specific plan or other closely managed specialty network, or who has a participation contract with Us. A Member who is admitted into a Hospital and receives lodging and food, as well as treatment.
Ineligible Charges. Charges for health care services that are not Covered Services because the services are not Medically Necessary or Pre-Admission Certification was not obtained. Such charges are not eligible for payment. A facility which does not meet the minimum requirements to become an In-Network Hospital. Services rendered to a Member by such a Hospital are not eligible for payment. A Provider which does not meet the minimum requirements to become an In-Network Provider or with whom Alliant does not directly contract. Services rendered to a Member by such a Provider are not eligible for payment. The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of one year of frequent, unprotected heterosexual vaginal intercourse. This does not include conditions for men when the cause is a vasectomy or orchiectomy or for women when the cause is tubal ligation or hysterectomy. A person actively employed by the Group (or one of that person’s eligible Dependents) on the original Effective Date of the group health plans coverage between Alliant and the Group or currently enrolled through the Group under an Alliant Contract. Bodily harm from a non-occupational accident. Covered Services provided to Members by their Physician through Network Hospital and Network Providers. A Member has direct access to primary and specialty care directly from any In- Network Physician.