Preventive Care Services and Early Detection Services Sample Clauses

Preventive Care Services and Early Detection Services. In accordance with PPACA, this agreement provides coverage rendered to a member for early detection services, preventive care services, and immunizations/vaccinations as set forth below and in accordance with the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); or • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services (for example, pediatric preventive office visits), and adult and pediatric immunizations/vaccination are based on the most currently available guidelines and are subject to change. The amount you pay for early detection services, preventive care services, and adult and pediatric immunizations/vaccination is indicated in the Summary of Medical Benefits.
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Preventive Care Services and Early Detection Services for immunization and vaccination coverage information. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.
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Preventive Care Services and Early Detection Services. In accordance with PPACA, this agreement provides coverage rendered to a subscriber for early detection services, preventive care services, and immunizations/vaccinations as set forth in the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); and • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services, and adult and pediatric immunizations/vaccination are based on the most currently available guidelines and are subject to change. The level of coverage for early detection services, preventive care services, and adult and pediatric immunizations/vaccination is indicated in the Summary of Medical Benefits One pap smear annually is covered at the level of coverage for early detection services as shown in the Summary of Benefits. The level of coverage for your second and subsequent pap smear is covered as a lab test. For information about lab, radiology, and machine tests see Section 3.8 - Diagnostic Imaging, Lab, and Machine Tests. Vaccinations/Immunizations Adult Vaccinations/Immunizations We cover adult preventive vaccinations and immunizations in accordance with current guidelines. These guidelines are subject to change. Our allowance includes the administration and the vaccine. If any of the above immunizations are provided as part of an office visit, only your office visit copayment and deductible (if any) will be applied. If your doctor administers any of the above immunizations and vaccinations in the absence of an office visit, the immunization and vaccination is covered up to the benefit level shown in the Summary of Medical Benefits.
Sample 1
Preventive Care Services and Early Detection Services. In accordance with PPACA, this agreement provides coverage rendered to a member for early detection services, preventive care services, and immunizations/vaccinations as set forth below and in accordance with the guidelines of the following resources:
Sample 1
Preventive Care Services and Early Detection Services. 3.30 • Cancer Screenings 3.30 The level of coverage for preventive care and early detection services is based on the type of service, with the exception of the cancer screenings mentioned below. See Section 3.30 for details. • Outpatient Hospital Facility 3.30 This level of coverage applies to the following cancer screenings: mammograms, pap smear, and PSA test. 100% coverage After deductible 80% coverage For information on other prevention services see Section 3.30. • Outpatient Non- Hospital facility 3.30 This level of coverage applies to the following cancer screenings: mammograms, pap smear, and PSA test. 100% coverage After deductible 80% coverage For information on other prevention services see Section 3.30. • Adult Immunizations 3.30 100% coverage After deductible 80% coverage • Pediatric Immunizations 3.30 100% coverage After deductible 80% coverage • Travel Immunizations 3.30 As recommended by the Centers for Disease Control and Prevention. 100% coverage After deductible 80% coverage Private Duty Nursing * 3.31 80% coverage After deductible 80% coverage** Radiation Therapy 3.32 • Inpatient 3.32 100% coverage After deductible 80% coverage • Outpatient 3.32 100% coverage After deductible 80% coverage Continued Summary of Medical Benefits See Important Note from First Page Type of Service Section Level of Coverage Benefit Limit Network Provider Non-Network Provider Respiratory Therapy 3.33 See program requirements in Section 3.33. 100% coverage After deductible 80% coverage Skilled Care in a Nursing Facility * 3.34 100% coverage After deductible 80% coverage Smoking Cessation Programs 3.35
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  • Administration Services When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. Site of Care Program For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

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