Pregnancy Terminations. Medically Necessarypregnancyterminations(abortions) mustbeprovided by a licensed Physician, but HMO may allow other health Providers to provide Covered Services that may be provided under applicable state law by such Providers, including cesarean section, termination of ectopic pregnancy, and spontaneous termination of pregnancy occurring during a period of gestation in which a viable birth is not possible. Elective, non- therapeutic abortions are not covered. Services may require Preauthorization by HMO. Behavioral Health Services Outpatient Mental Health Care. Covered Services include diagnostic evaluation and treatment or crisis intervention when authorized by HMO or its designated behavioral health administrator.
Pregnancy Terminations. AHCCCS covers pregnancy termination if the pregnant member suffers from a physical disorder, physical injury, or physical illness, including a life endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the member in danger of death unless the pregnancy is terminated, or the pregnancy is a result of rape or incest. The attending physician must acknowledge that a pregnancy termination has been determined medically necessary by submitting the Certificate of Necessity for Pregnancy Termination. This form must be submitted to the Contractor’s Medical Director and meet the requirements specified in the AMPM. The Certificate must certify that, in the physician's professional judgment, one or more of the previously mentioned criteria have been met.
Pregnancy Terminations. Where non-medically necessary. Pregnancy, Conception, Childbirth and Post-natal costs whether normal or complicated, including the transfer of a pregnant woman to hospital to give routine childbirth or air travel when the Insured Person is more than 28 weeks pregnant, except where cover is provided under the Maternity Benefit. Prophylactic or Preventative Treatment: The costs of surgery, or treatment, or service, or dietary supplements that are primarily for the prevention of possible ill-health, or to counter the natural effects of ageing. Malaria prophylaxis and vaccinations (except where stated in the Benefit Table), such as travel vaccinations, flu vaccinations, epidemics and pandemics, and any other vaccinations Self-Inflicted Injury and Negligence: Any self-inflicted injury, needless self-exposure to peril (except in an attempt to save human life), suicide or attempted suicide. If the member is involved, or participates, in activities or habits against the advice of a medical practitioner, or counsellor, or against health and safety regulations, where such involvement could lead to injury or harm. Sex Changes: any treatment directly or indirectly associated with sex changes or gender reassignments, or consequences of such treatment unless associated with newly born infants and subject to the benefits available to members under the New Born benefit. Sleep-Related Breathing Disorders: Treatment for snoring, sleep apnoea and other related conditions. Travel and Accommodation Costs: unless specifically agreed by Alliance Health and only for treatment received as an in-patient. Unless otherwise covered by your ambulance, or evacuation benefits. Travel Costs: Travel costs for treatment. Travel costs (evacuation and/or repatriation) where the Insured has travelled against medical advice Treatment at and Admissions to Institutional Facilities: Treatment received in any facility that is not recognised as a hospital Treatment by a Relative: Treatment performed by a Medical Practitioner or Specialist, who is related to the Insured Person, unless previously approved by Alliance Health How to Claim
Pregnancy Terminations. Medically Necessary pregnancy terminations (abortions) for a pregnancy which, as certified by a Physician, places the woman in danger of death unless an abortion is performed are covered. Abortions must be provided by a licensed Physician, but HMO may allow other health Providers to provide Covered Services that may be provided under applicable state law by such Providers, including cesarean section, termination of ectopic pregnancy, and spontaneous termination of pregnancy occurring during a period of gestation in which a viable birth is not possible. Elective, non‐therapeutic abortions are not covered. Services may require Preauthorization by HMO. Behavioral Health Services Benefits and coverage for behavioral health services are provided under the same terms and conditions applicable to this plan's medical and surgical benefits and coverage. HMO will not impose treatment limitations on benefits for behavioral health services that are generally more restrictive than treatment limitations imposed on coverage of benefits for medical or surgical services. Outpatient Mental Health Care. Covered Services include diagnostic evaluation and treatment or crisis intervention when authorized by HMO or its designated behavioral health administrator.
