Medical and Surgical Services Sample Clauses

Medical and Surgical Services. A. Physician’s services at the:
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Medical and Surgical Services. The Contractor shall determine the medical necessity for emergency and non- emergency inpatient hospital admission prior authorizations, continued stays, Retroactive Eligibility Reviews and Retrospective Reviews for inpatient medical/surgical services to eligible Mississippi Medicaid beneficiaries utilizing the Division’s approved criteria and policies.
Medical and Surgical Services. 7.5.6.1 The Contractor shall make available through its Network Providers the following Medical and Surgical Services:
Medical and Surgical Services. The Contractor shall provide the following medical and surgical services as Covered Services: Early and Periodic Screening, Diagnostic and Treatment (“EPSDT”) services, as defined in Section 1905(r) of the Social Security Act; Primary Care Physician visits, including nursing services; Specialist treatment, once referred by the selected PCP if outside of the Enrollee’s PPN; Sub-specialist treatment, once referred by the selected PCP if outside of the Enrollee’s PPN; Physician home visits when Medically Necessary; Respiratory therapy, without limitations; Anesthesia services (except for epidural anesthesia); Radiology services; Pathology services; Surgery; Outpatient surgery facility services; Nursing services; Voluntary sterilization of men and women of legal age and sound mind, provided that they have been previously informed about the medical procedure’s implications, and that there is evidence of Enrollee’s written consent by completing the Sterilization Consent Form included as Attachment 22 to this Contract; Prosthetics, including the supply of all extremities of the human body including therapeutic ocular prosthetics, segmental instrument tray, and spine fusion in scoliosis and vertebral surgery; Ostomy equipment for outpatient-level ostomized patients; Transfusion of blood and blood plasma services, without limitations, including the following: Antihemophilic recombinant factor VIII; Antihemophilic recombinant factor IX; Anti-inhibitor coagulant complex (Feiba); and Antihemophilic factor VIII, human/Von Willebrand factor complex. Services to patients with Level 1 or Level 2 of chronic renal disease (Levels 3 to 5 are included in Special Coverage in Section 7.7). Chronic renal disease Levels 1 and 2 are defined as follows:
Medical and Surgical Services. 7.5.6.1 The Contractor shall provide the following Medical and Surgical Services:
Medical and Surgical Services. Routine Adult Physical Exam $10 co-payment 20% of plan allowance Well-child care $10 Plan pays 80% of plan allowance Cancer screening – mammogram, prostate screening and PAP tests No charge Plan pays 80% of plan allowance Non-routine office visit $10 co-payment 20% of plan allowance Allergy shots $10 co-payment 20% of plan allowance Maternity care $10 1st visit only 20% of plan allowance Surgery, laboratory test X-rays No charge 20% of plan allowance Hospital Services (Semi-private room) Inpatient Medical • Facility • Physician No charge No charge 20% of plan allowance 20% of plan allowance Out patient Medical • Facility No charge No charge • Physician No charge No charge • Emergency Room $35 $35 Mental Health Care Inpatient services (limited to 45 days per calendar year) • Facility • Physician No charge No charge 20% of plan allowance 20% of plan allowance Outpatient services (per calendar year) • Visits 1-40 • Visits 41- 20% of plan allowance 20% of plan allowance 20% of plan allowance 20% of plan allowance Substance Abuse Detoxification No charge 20% of plan allowance Inpatient rehabilitation services (limited to 30 days per calendar year) • Facility • Physician No charge No charge 20% of plan allowance 20% of plan allowance Outpatient rehabilitation services (limited to 30 days per calendar year) • Facility No charge 20% of plan allowance Prescription Drug $ 5 co-pay (retail generic) $10 co-pay (retail brand formulary) $20 (retail brand non-formulary) $10 co-pay (mail generic) $20 co-pay (mail brand formulary) $40 (mail brand non-formulary)

Related to Medical and Surgical Services

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Technical Services Party B will provide technical services and training to Party A, taking advantage of Party B’s advanced network, website and multimedia technologies to improve Party A’s system integration. Such technical services shall include:

  • Legal Services If this Agreement is for legal services, this section is applicable. Contractor shall: (i) adhere to legal cost and billing guidelines designated by the JBE; (ii) adhere to litigation plans designated by the JBE, if applicable; (iii) adhere to case phasing of activities designated by the JBE, if applicable; (iv) submit and adhere to legal budgets as designated by the JBE; (v) maintain legal malpractice insurance in an amount not less than the amount designated by the JBE; and (vi) submit to legal bill audits and law firm audits if so requested by the JBE, whether conducted by employees or designees of the JBE or by any legal cost-control provider retained by the JBE for that purpose. Contractor may be required to submit to a legal cost and utilization review as determined by the JBE. If (a) the Contract Amount is greater than $50,000, (b) the legal services are not the legal representation of low- or middle-income persons, in either civil, criminal, or administrative matters, and (c) the legal services are to be performed within California, then Contractor agrees to make a good faith effort to provide a minimum number of hours of pro xxxx legal services, or an equivalent amount of financial contributions to qualified legal services projects and support centers, as defined in section 6213 of the Business and Professions Code, during each year of the Agreement equal to the lesser of either (A) thirty (30) multiplied by the number of full time attorneys in the firm’s offices in California, with the number of hours prorated on an actual day basis for any period of less than a full year or (B) the number of hours equal to ten percent (10%) of the Contract Amount divided by the average billing rate of the firm. Failure to make a good faith effort may be cause for nonrenewal of this Agreement or another judicial branch or other state contract for legal services, and may be taken into account when determining the award of future contracts with a Judicial Branch Entity for legal services.

  • ELECTRICAL SERVICES A. Landlord shall provide electric power for a combined load of 3.0 xxxxx per square foot of useable area for lighting and for office machines through standard receptacles for the typical office space.

  • Marketing Services The Manager shall provide advice and assistance in the marketing of the Vessels, including the identification of potential customers, identification of Vessels available for charter opportunities and preparation of bids.

  • Specific Services Contractor agrees to furnish the following services: Contractor shall provide the services described in Exhibit “A”. No additional services shall be performed by Contractor unless approved in advance in writing by the County stating the dollar value of the services, the method of payment, and any adjustment in contract time or other contract terms. All such services are to be coordinated with County and the results of the work shall be monitored by the Health and Human Services Agency Director or his or her designee.

  • Medical, Dental and Vision Benefits If Executive’s employment with the Bank is subject to a Termination, then, to the extent that Executive or any of Executive’s dependents may be covered under the terms of any medical, dental or vision plans maintained for active employees of the Bank or any Affiliate, the Bank shall provide Executive and those dependents with coverage equivalent to the coverage received while Executive was employed with the Bank for as long as Executive is eligible for and elects coverage under the health care continuation rules of the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”). Executive will be required to pay the same amount as Executive would pay if Executive continued in active employment with the Bank during such period. Such coverage shall be provided only to the extent that it does not result in any additional tax or other penalty being imposed on the Bank or any Affiliate. The coverage under this Section 4(e) may be procured directly by the Bank (or any Affiliate, if appropriate) apart from and outside of the terms of the respective plans, provided that Executive and Executive’s dependents comply with all of the terms of the substitute medical, dental or vision plans, and provided, further, that the cost to the Bank shall not exceed the cost for continued COBRA coverage. In the event Executive or any of Executive’s dependents is or becomes eligible for coverage under the terms of any other medical, dental or vision plan of a subsequent employer with plan benefits that are comparable to Bank (or any Affiliate) plan benefits, the Bank’s obligations under this Section 4(e) shall cease with respect to the eligible Executive and dependents. Executive and Executive’s dependents must notify the Bank (or any Affiliate) of any subsequent employment and eligibility for such comparable coverage.

  • Shared Services 5.1.1 ETFO agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis.

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • SPECIAL SERVICES Should the Trust have occasion to request the Adviser to perform services not herein contemplated or to request the Adviser to arrange for the services of others, the Adviser will act for the Trust on behalf of the Fund upon request to the best of its ability, with compensation for the Adviser's services to be agreed upon with respect to each such occasion as it arises.

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