Outpatient Emergency Sample Clauses

Outpatient Emergency. Service - medical service necessary for Policyholder being in urgent situation provided in medical institution during insurance period (costs of clinical, instrumental, laboratory analysis and outpatient manipulations, medication, preparations), which doesn’t need delay more than 24 hours in medical institution.
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Outpatient Emergency. (Hospital and Physician) Emergency Medical and Emergency Accident - Treatment in a hospital or physician's office for accidental injuries or sudden and unexpected medical conditions with severe life-threatening symptoms only. Note: Non-life threatening emergency medical and accident treatment is covered after the deductible at PPO & Non-PPO network coinsurance levels. (The Supplemental Accident Inpatient Psychiatric & Substance Abuse: Maximum Lifetime Benefits of $50,000 for inpatient and outpatient services. Inpatient care Outpatient Psychiatric & Substance Abuse: Maximum Lifetime Benefits of $50,000 for inpatient and outpatient services. Outpatient care Medical/Surgical Care: Including Durable Medical Equipment, Home Infusion Therapy and Advanced Practice Nurses. Payments based on the Schedule of Maximum Allowances for all PPO Network providers. PPO Providers have agreed to accept the Schedule of Maximum Allowances as payment in full for covered services, excluding your deductible and any coinsurance. Other Covered Services (Services for which a PPO Network does not apply): Leg, $1,000 Individual $2,000 Family (Aggregate) 100% 100% 100% 100% 100% 100%** 80% 90% after $75 co-pay, co-pay waived if admitted 80% 80% 80% $1,500 Individual $3,000 Family (Aggregate) 80% 80% 80% 80% 75%** 80%** 60% 90% after $75 co-pay, co-pay waived if admitted 60% 60% 60% arm, and neck braces; private duty nursing; ambulance services; allergy shots; oxygen and its administration; blood and blood components; surgical dressings; casts and splints; Prescription Drug Card: 80% $15 co-pay 75% after Prescription Drug benefit, 34 day supply paid at 100% after copayment at all participating pharmacies. Mail Order Prescription Drug Program: 90 day supply generic; $25 co-pay formulary; $40 co-pay nonformulary $15, $25 or $40 co- pay*** BASIC PROVISIONS Medical Services Advisory (Inpatient Utilization Review): Notification required prior to all elective admissions, Private Duty Nursing, Skilled Nursing Facilities and Coordinated Home Care, Emergency and Obstetric Admission Notification required within 2 working days of admittance. If employee elects not to notify MSA Advisory or follow advice given, hospital benefits are reduced by $200. ** Indicates that the Deductible does not apply. ***If a generic is available and a brand name is dispensed, the employee will pay the difference between the brand name and the generic plus the brand name co-pay; the only exception will be when the gener...
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Related to Outpatient Emergency

  • 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.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Inpatient In accordance with Rhode Island General Law §27-20-17.1, this agreement covers a minimum inpatient hospital stay of forty- eight (48) hours from the time of a vaginal delivery and ninety-six (96) hours from the time of a cesarean delivery: • If the delivery occurs in a hospital, the hospital length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple births, at the time of the last delivery). • If the delivery occurs outside a hospital, the hospital length of stay begins at the time the mother or newborn is admitted as a hospital in connection with childbirth. Any decision to shorten these stays shall be made by the attending physician in consultation with and upon agreement with you. In those instances where you and your infant participate in an early discharge, you will be eligible for: • up to two (2) home care visits by a skilled, specially trained registered nurse for you and/or your infant, (any additional visits must be reviewed for medical necessity); and • a pediatric office visit within twenty-four (24) hours after discharge. See Section 3.23 - Office Visits for coverage of home and office visits. We cover hospital services provided to you and your newborn child. Your newborn child is covered for services required to treat injury or sickness. This includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities as well as routine well-baby care.

  • Dependent Care Assistance Program The County offers the option of enrolling in a Dependent Care Assistance Program (DCAP) designed to qualify for tax savings under Section 129 of the Internal Revenue Code, but such savings are not guaranteed. The program allows employees to set aside up to five thousand dollars ($5,000) of annual salary (before taxes) per calendar year to pay for eligible dependent care (child and elder care) expenses. Any unused balance is forfeited and cannot be recovered by the employee.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following:

  • Outpatient Services The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:

  • Covered Services Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.

  • Service Animals Humber Residence acknowledges the rights of persons with disabilities to retain their service animal while living in Residence. In order to preserve the health and safety of all people and animals living or working in the Residence environment, the Resident will notify the Residence Office that they require a service animal and will provide documentation as outlined in the Accessibility for Ontarians with Disabilities Act confirming that the Resident requires the service animal. The Resident will also complete a Service Animal Agreement with the Residence Manager or designate, and agrees to adhere to the requirements within it.

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • 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.

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