Enhanced Services The State encourages the Contractor to cover programs that enhance the general health and well-being of its Hoosier Healthwise members, including programs that address preventive health, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise program. In addition, all enhanced services shall comply with the member incentives guidelines set forth in Section 6.2.2 and other relevant state and federal rules regarding inducements. All enhanced services offered by the Contractor must be pre-approved by OMPP prior to initiating such services. Enhanced services may include, but are not limited to, such items as:
Analytics 1.1. IFS may track and analyze the usage of the IFS Offering for purposes of determining usage made of the IFS Offering, for the purposes of security, to assist customers, and for improving the Software and Services and the user experience in using such Software and Services. For example, IFS may use this information to help customers derive more value from the Software and Services, to understand and analyze trends, or to track which features are used most often in order to improve the Software and Services. IFS may share anonymous usage data with its service providers for the purpose of helping in such tracking, analysis and improvements. Additionally, IFS may share such anonymous usage data on an aggregate basis in the normal course of operating their business; for example, IFS may share information publicly to show trends about the general use of its software and services. TERMS - SERVICES
Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity
Firefighters Any truck with an inoperative aerial ladder shall be regularly and routinely staffed with one (1) officer and five (5) firefighters for the period of time that the aerial ladder is inoperative, or until such time as the truck with the inoperative aerial ladder is replaced with a truck with an operative aerial ladder. At 0800 and 2000 hours, all trucks shall be staffed with one (1) officer and four (4) firefighters, and any truck with an inoperative aerial ladder shall be staffed with one (1) officer and five (5) firefighters.
Special Service networks The following services must be received from special service network providers in order to be covered. All terms and conditions outlined in the Summary of Benefits apply.
Classroom Teachers b. School counselors
Destination CSU-Pueblo scholarship This articulation transfer agreement replaces all previous agreements between CCA and CSU-Pueblo in Bachelor of Science in Physics (Secondary Education Emphasis). This agreement will be reviewed annually and revised (if necessary) as mutually agreed.
Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.
Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. Preauthorization may be required for certain surgical services. Reconstructive Surgery for a Functional Deformity or Impairment This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia. Preauthorization may be required for these services.
Prescription Glasses This plan covers prescription glasses as follows: • Frames - one (1) collection frame per plan year; • Lenses - one (1) pair of glass or plastic collection lenses per plan year. This includes single vision, bifocal, trifocal, lenticular, and standard progressive lenses. This plan covers the following lens treatments: • UV treatment; • tint (fashion, gradient, and glass-grey); • standard plastic scratch coating; • standard polycarbonate; and • photocromatic/transitions plastic. Contact Lenses (in lieu of prescription glasses) This plan covers one (1) supply of contact lenses as follows: • conventional contact lenses - one (1) pair per plan year from a selection of provider designated contact lenses; or • extended wear disposable lenses - up to a 6-month supply of monthly or two- week single vision spherical or toric disposable contact lenses per plan year; or • daily wear disposable lenses - up to a 3-month supply of daily single vision spherical disposable contact lenses per plan year. This plan also covers the evaluation, fitting, or follow-up care related to contact lenses. This plan covers additional contact lenses if your prescribing network provider submits a verification form, with the regular claim form, verifying that you have one of the following conditions: • anisometropia of 3D in meridian powers; • high ametropia exceeding -10D or +10D in meridian powers; • keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses; and • vision improvement for members whose vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.
