NETWORK BENEFIT Sample Clauses
The NETWORK BENEFIT clause defines the advantages or privileges that a party receives by being part of a particular network, such as access to preferred pricing, services, or resources. In practice, this clause may specify eligibility requirements, the scope of benefits, and any conditions or limitations on their use—for example, allowing members to receive discounts or participate in exclusive programs. Its core function is to clearly outline the tangible benefits of network participation, ensuring both parties understand the value provided and reducing potential disputes over entitlements.
NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospitalization services and inpatient physician charges when provided by or arranged through the network. • Outpatient care provided by or arranged through the network will be covered subject to a $20 per visit copay. Effective January 1, 2019, the outpatient visit copayment will be $25. • The copayment for emergency room services will be $70. Effective January 1, 2019, the copayment for emergency room services will be $100. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. Alcohol and Other Substance Abuse Coverage • Paid-in-full medically necessary care for hospitalization or alcohol/substance abuse facilities when pro- vided by or arranged through the network; • Outpatient care provided by or arranged through the network will be subject to the participating provider office visit copay.
NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospital services and inpatient physician charges when provided by, or arranged through, the network; • Effective April 1, 2010, outpatient care provided by, or arranged through, the network will be covered subject to a $20 per visit copayment; • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. - Benefit Maximums • Effective January 1, 2010 medically necessary inpatient alcohol and substance abuse treatment will be unlimited.
NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospital services and inpatient physician charges when provided by, or arranged through, the network; • Effective April 1,2010, outpatient care provided by, or arranged through, the network will be covered subject to a $20 per visit copayment. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. - Benefit Maximums • Effective January 1,2010 medically necessary inpatient alcohol and substance abuse treatment will be unlimited. 12.14(b) NON-NETWORK BENEFIT - Mental Health Medically necessary care rendered outside of the network will be subject to the following provisions: • Coincident with the increase in the Basic Medical deductible and coinsurance, the mental health basic medical deductible and coinsurance will increase accordingly. • The methodology for calculating non-network inpatient and outpatient reimbursement will be the same as the methodology for non-rietwork hospital and medical services; - Substance Abuse • Medically necessary inpatient alcohol and substance abuse treatment will be unlimited effective January 1,2010. • Coincident with the increase in the Basic Medical deductible and coinsurance, the substance abuse deductible and coinsurance will increase accordingly effective January 1,2010. • Effective January 1, 2010 the methodology for calculating non-network inpatient and outpatient reimbursement will be the same as the methodology for non network hospital and medical services; • Expenses applied against the deductible and coinsurance levels indicated above will not apply against any deductible or coinsurance maximums under the basic medical portion of the Plan. Effective January 1, 2012, covered expenses for non-network mental health and substance abuse treatment will be included in the combined deductible and combined coinsurance maximum. - Disease Management - Under the Mental Health and Substance Abuse Program a disease management program for depression is available. Effective, March 31, 2010, or as soon as practicable, disease management programs for eating disorders, including appropria...
NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospital services and inpatient physician charges when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be covered subject to a $20 per visit copayment. Effective as soon as practicable, outpatient care provided by, or arranged through, the network will be covered subject to a $25 per visit copayment. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Use Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance use facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. - Benefit Maximums
NETWORK BENEFIT. Mental Health Coverage • Paid in full medically necessary hospitalization services and inpatient physician charges when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be covered subject to a $18 per visit copayment. Effective July 1, 2009, the outpatient per visit copayment will increase to $20. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider $18 office visit copayment. Effective July 1, 2009, the outpatient per visit copayment will increase to $20. - Benefit Maximums • Effective January 1, 2010 medically necessary inpatient alcohol and substance abuse treatment shall be unlimited.