Medically Appropriate Sample Clauses

Medically Appropriate. The term “Medically Appropriate” means services and medical supplies which are required for prevention, diagnosis, or treatment of sickness or injury, and which are:
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Medically Appropriate. Medically Appropriate" means Medical Services which, under provisions of this Agreement, are determined to be: (i) appropriate for the prevention, diagnosis or treatment of the symptoms, injury or disease; (ii) provided for the prevention, diagnosis or direct care and treatment of the symptoms, injury or disease; (iii) within medical, dental or other health care practice standards within the health care community; (iv) not primarily for the convenience of Hospital, Eligible Subscriber or Participating Provider providing Covered Services to Eligible Subscriber; and (v) an appropriate level of service or supply needed to provide safe and adequate care.
Medically Appropriate. Health Care Services that are Medically Necessary and that are determined in accordance with applicable laws, rules, regulations and professional standards to be (1) consistent with the symptoms of a health condition or treatment of a health condition, illness, or injury; (2) appropriate with regard to the most current standard of practice for the safe and effective assessment, treatment, or management of the applicable health condition, illness, or injury as determined by the relevant scientific community and professional bodies; (3) not solely for convenience of a Enrollee or the Health Care Professional providing the Health Care Services; and (4) more cost-effective than alternative services or supplies that could be employed for the safe and effective assessment, treatment, or management of the applicable health condition, illness, or injury under prevailing standards of scientific knowledge and clinical practice among practitioners with like credentials providing Health Care Services in the State.

Related to Medically Appropriate

  • Medically Necessary In general, We will not Cover any dental service, procedure, treatment, test or device that We determine is not Medically Necessary. If an External Appeal Agent certified by the State overturns Our denial, however, We will Cover the service, procedure, treatment, test or device for which coverage has been denied, to the extent that such service, procedure, treatment, test or device, is otherwise Covered under the terms of this Contract.

  • MEDICALLY FRAGILE STUDENTS 1. If a teacher will be providing instructional or other services to a medically fragile student, the teacher or another adult who will be present when the instruction or other services are being provided will be advised of the steps to be taken in the event an emergency arises relating to the student's medical condition.

  • Diagnostic procedures to aid the Provider in determining required dental treatment.

  • Diagnosis For a condition to be considered a covered illness or disorder, copies of laboratory tests results, X-rays, or any other report or result of clinical examinations on which the diagnosis was based, are required as part of the positive diagnosis by a physician.

  • Drugs Possession or use of drugs by the Student, any person present in the residence with the Student, or any person present in the Student’s residence with the permission of the Student during the Student’s absence, are strictly prohibited in any UCF DHRL facility. Prohibited drugs include, but are not limited to:

  • Medical There shall be an open enrollment period for medical coverage in each year of this Agreement. An employee may elect no medical coverage during any open enrollment period. An employee who has elected no medical coverage may elect medical coverage during an open enrollment period. No pre-existing condition limitations will apply.

  • Speech Therapy This plan covers speech therapy services when provided by a qualified licensed provider and part of a formal treatment plan for: • loss of speech or communication function; or • impairment as a result of an acute illness or injury, or an acute exacerbation of a chronic disease. Speech therapy services must relate to: • performing basic functional communication; or • assessing or treating swallowing dysfunction. See Autism Services when speech therapy services are rendered as part of the treatment of autism spectrum disorder. The amount you pay and any benefit limit will be the same whether the services are provided for habilitative or rehabilitative purposes.

  • Outpatient If you receive dialysis services in a hospital's outpatient unit or in a dialysis facility, we cover the use of the treatment room, related supplies, solutions, drugs, and the use of the dialysis machine. In Your Home If you receive dialysis services in your home and the services are under the supervision of a hospital or outpatient facility dialysis program, we cover the purchase or rental (whichever is less, but never to exceed our allowance for purchase) of the dialysis machine, related supplies, solutions, drugs, and necessary installation costs. Related Exclusions If you receive dialysis services in your home, this agreement does NOT cover: • installing or modifying of electric power, water and sanitary disposal or charges for these services; • moving expenses for relocating the machine; • installation expenses not necessary to operate the machine; or • training you or members of your family in the operation of the machine. This agreement does NOT cover dialysis services when received in a doctor’s office.

  • Clinical 2.1 Provides comprehensive evidence based nursing care to patients including assessment, intervention and evaluation.

  • Immunization B11.01 The Employer shall provide the employee with immunization against communicable diseases where there is a risk of incurring such diseases in the performance of his duties.

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