{"component": "clause", "props": {"groups": [{"size": 14, "snippet_links": [{"key": "the-plan", "type": "clause", "offset": [0, 8]}, {"key": "benefits-for", "type": "clause", "offset": [26, 38]}, {"key": "prosthetic-devices", "type": "definition", "offset": [152, 170]}, {"key": "the-member", "type": "clause", "offset": [337, 347]}, {"key": "medical-needs", "type": "clause", "offset": [350, 363]}], "samples": [{"hash": "6GskUpvamAo", "uri": "/contracts/6GskUpvamAo#prostheses", "label": "Member Benefit Agreement", "score": 31.6744918823, "published": true}, {"hash": "cYM6z0D6qvI", "uri": "/contracts/cYM6z0D6qvI#prostheses", "label": "Member Benefit Agreement", "score": 27.3696098328, "published": true}, {"hash": "h3AiOb7RToz", "uri": "/contracts/h3AiOb7RToz#prostheses", "label": "Member Benefit Agreement", "score": 25.3832988739, "published": true}], "snippet": "The Plan does not provide Benefits for dental prostheses, including implants that support mandibular prosthesis. The Plan does not provide Benefits for prosthetic devices to replace, in whole or in part, an arm or a leg, that are designed exclusively for athletic purposes or higher technology (e.g. titanium, microprocessor) than meets the Member\u2019s medical needs. Covered prostheses described in section 4.B.8 and 4.B.22 are Covered under the Plan. No other prostheses are covered.", "hash": "fd6956eaef24fb3137f73e799dac1ad1", "id": 1}, {"size": 11, "snippet_links": [{"key": "body-part", "type": "definition", "offset": [44, 53]}, {"key": "an-accident", "type": "clause", "offset": [73, 84]}, {"key": "placement-of", "type": "definition", "offset": [111, 123]}, {"key": "surgical-procedure", "type": "clause", "offset": [150, 168]}, {"key": "surgical-services", "type": "clause", "offset": [192, 209]}, {"key": "payment-for", "type": "clause", "offset": [211, 222]}, {"key": "based-on", "type": "definition", "offset": [250, 258]}, {"key": "allowable-fee", "type": "definition", "offset": [263, 276]}, {"key": "the-plan", "type": "clause", "offset": [304, 312]}, {"key": "pay-for", "type": "clause", "offset": [322, 329]}], "samples": [{"hash": "3rrl0ILr4bU", "uri": "/contracts/3rrl0ILr4bU#prostheses", "label": "Health Insurance Plan", "score": 35.6872739562, "published": true}, {"hash": "eQJ6tUK2jZW", "uri": "/contracts/eQJ6tUK2jZW#prostheses", "label": "Health Insurance Contract", "score": 35.6069068909, "published": true}, {"hash": "70gmvBzrZ4f", "uri": "/contracts/70gmvBzrZ4f#prostheses", "label": "Health Insurance Contract", "score": 35.561542511, "published": true}], "snippet": "\u200c The appropriate devices used to replace a body part missing because of an Accident, Injury, or Illness. When placement of a prosthesis is part of a surgical procedure, it will be paid under Surgical Services. Payment for deluxe prosthetics will be based on the Allowable Fee for a standard prosthesis. The Plan will not pay for the following items:", "hash": "7f4e4064ceff6395f77f93380385f9e5", "id": 2}, {"size": 5, "snippet_links": [{"key": "cost-of", "type": "clause", "offset": [0, 7]}, {"key": "inclusive-of", "type": "clause", "offset": [22, 34]}, {"key": "wherever-required", "type": "clause", "offset": [50, 67]}], "samples": [{"hash": "kliJuF0mo6w", "uri": "/contracts/kliJuF0mo6w#prostheses", "label": "Memorandum of Understanding", "score": 32.131816864, "published": true}, {"hash": "19tdIPkaNec", "uri": "/contracts/19tdIPkaNec#prostheses", "label": "Memorandum of Understanding", "score": 24.5222454071, "published": true}, {"hash": "1OHW3zw4N6p", "uri": "/contracts/1OHW3zw4N6p#prostheses", "label": "Memorandum of Understanding", "score": 23.5489387512, "published": true}], "snippet": "Cost of prosthesis is inclusive of foot and shoe, wherever required.", "hash": "2a6970342f3ac67341f398ac43ebd3a0", "id": 3}, {"size": 3, "snippet_links": [{"key": "cost-of", "type": "clause", "offset": [3, 10]}, {"key": "inclusive-of", "type": "clause", "offset": [25, 37]}, {"key": "wherever-required", "type": "clause", "offset": [53, 70]}, {"key": "the-materials", "type": "definition", "offset": [120, 133]}, {"key": "bureau-of-indian-standards", "type": "definition", "offset": [144, 170]}, {"key": "replacement-guarantee", "type": "definition", "offset": [285, 306]}, {"key": "replacement-of", "type": "clause", "offset": [343, 357]}], "samples": [{"hash": "75cq5CGLHmn", "uri": "/contracts/75cq5CGLHmn#prostheses", "label": "Memorandum of Understanding", "score": 22.603012085, "published": true}, {"hash": "j9SNn5DZ25h", "uri": "/contracts/j9SNn5DZ25h#prostheses", "label": "Memorandum of Understanding", "score": 19.0, "published": true}], "snippet": "i) Cost of prosthesis is inclusive of foot and shoe, wherever required.\nii) Prosthesis must have been manufactured with the materials with BIS (Bureau of Indian Standards) certification.\niii) All prosthesis shall be functional in nature.\niv) Manufacturer shall give minimum of 3 years replacement Guarantee.\nv) Manufacturer shall provide free replacement of leather parts/straps etc., during this period apart from replacement guarantee.", "hash": "0ef7e86469e83798c7f673e67a16d7b2", "id": 4}, {"size": 2, "snippet_links": [{"key": "body-parts", "type": "definition", "offset": [47, 57]}, {"key": "not-limited", "type": "clause", "offset": [73, 84]}, {"key": "intraocular-lens", "type": "definition", "offset": [144, 160]}, {"key": "contact-lenses", "type": "definition", "offset": [173, 187]}, {"key": "not-covered", "type": "definition", "offset": [238, 249]}, {"key": "except-as-specifically", "type": "clause", "offset": [250, 272]}], "samples": [{"hash": "8vfHhwYdEmq", "uri": "/contracts/8vfHhwYdEmq#prostheses", "label": "Group Hospital and Professional Service Agreement", "score": 24.659860611, "published": true}, {"hash": "2XYq4nSJ7sF", "uri": "/contracts/2XYq4nSJ7sF#prostheses", "label": "Group Hospital and Professional Service Agreement", "score": 23.1902809143, "published": true}], "snippet": "Any expenses that specifically replace missing body parts including, but not limited to, artificial limbs, mammary prostheses, artificial eyes, intraocular lens implants or contact lenses after cataract surgery and colostomy supplies are not covered except as specifically stated.", "hash": "359bfd56716ca1ab3f15d37f12e49050", "id": 5}, {"size": 2, "snippet_links": [{"key": "body-part", "type": "definition", "offset": [55, 64]}, {"key": "surgically-implanted", "type": "clause", "offset": [108, 128]}, {"key": "visual-aids", "type": "clause", "offset": [192, 203]}, {"key": "assist-the", "type": "clause", "offset": [227, 237]}, {"key": "visually-impaired", "type": "clause", "offset": [238, 255]}, {"key": "in-addition", "type": "clause", "offset": [359, 370]}, {"key": "the-device", "type": "clause", "offset": [455, 465]}, {"key": "food-and-drug-administration", "type": "definition", "offset": [495, 523]}, {"key": "for-general-use", "type": "definition", "offset": [537, 552]}, {"key": "types-of", "type": "clause", "offset": [569, 577]}, {"key": "medically-appropriate", "type": "clause", "offset": [578, 599]}, {"key": "health-net", "type": "definition", "offset": [623, 633]}, {"key": "repair-or-replacement", "type": "definition", "offset": [756, 777]}, {"key": "for-loss", "type": "clause", "offset": [778, 786]}, {"key": "not-covered", "type": "definition", "offset": [800, 811]}, {"key": "replace-or-repair", "type": "clause", "offset": [847, 864]}, {"key": "stem-cell", "type": "definition", "offset": [892, 901]}, {"key": "experimental-or-investigational", "type": "definition", "offset": [927, 958]}, {"key": "designated-transplant", "type": "clause", "offset": [1161, 1182]}, {"key": "member-physician", "type": "clause", "offset": [1260, 1276]}, {"key": "directed-to", "type": "definition", "offset": [1364, 1375]}, {"key": "a-designated", "type": "clause", "offset": [1376, 1388]}, {"key": "at-the-time", "type": "definition", "offset": [1430, 1441]}, {"key": "preferred-providers", "type": "clause", "offset": [1489, 1508]}, {"key": "network-providers", "type": "clause", "offset": [1621, 1638]}, {"key": "for-purposes-of", "type": "clause", "offset": [1639, 1654]}, {"key": "benefits-for", "type": "clause", "offset": [1680, 1692]}, {"key": "related-services", "type": "definition", "offset": [1720, 1736]}, {"key": "medically-necessary-services", "type": "definition", "offset": [1738, 1766]}, {"key": "in-connection-with", "type": "clause", "offset": [1768, 1786]}, {"key": "enrolled-member", "type": "definition", "offset": [1862, 1877]}, {"key": "for-the-donor", "type": "definition", "offset": [1913, 1926]}, {"key": "an-enrolled", "type": "clause", "offset": [1943, 1954]}, {"key": "related-to", "type": "clause", "offset": [2079, 2089]}, {"key": "organ-donation", "type": "clause", "offset": [2094, 2108]}, {"key": "subject-to", "type": "definition", "offset": [2160, 2170]}, {"key": "prior-authorization", "type": "definition", "offset": [2171, 2190]}, {"key": "transplant-center", "type": "definition", "offset": [2252, 2269]}, {"key": "information-on", "type": "clause", "offset": [2426, 2440]}, {"key": "how-to-elect", "type": "clause", "offset": [2467, 2479]}, {"key": "organ-donor", "type": "definition", "offset": [2489, 2500]}, {"key": "please-contact", "type": "clause", "offset": [2502, 2516]}, {"key": "contact-center", "type": "clause", "offset": [2530, 2544]}, {"key": "telephone-number", "type": "definition", "offset": [2552, 2568]}, {"key": "your-health", "type": "clause", "offset": [2572, 2583]}, {"key": "department-of-health-and-human-services", "type": "definition", "offset": [2610, 2649]}, {"key": "charges-for", "type": "clause", "offset": [2696, 2707]}, {"key": "expenses-and", "type": "clause", "offset": [2826, 2838]}, {"key": "hotel-accommodations", "type": "clause", "offset": [2839, 2859]}, {"key": "associated-with", "type": "definition", "offset": [2860, 2875]}, {"key": "a-limited", "type": "clause", "offset": [2933, 2942]}, {"key": "for-the-purpose-of", "type": "definition", "offset": [3145, 3163]}, {"key": "services-and-supplies", "type": "definition", "offset": [3343, 3364]}, {"key": "number-of-visits", "type": "clause", "offset": [3382, 3398]}, {"key": "benefits-and-copayments", "type": "clause", "offset": [3429, 3452]}], "samples": [{"hash": "2XYq4nSJ7sF", "uri": "/contracts/2XYq4nSJ7sF#prostheses", "label": "Group Hospital and Professional Service Agreement", "score": 23.1902809143, "published": true}], "snippet": "Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgically implanted hip joints, devices to restore speaking after laryngectomy and visual aids (excluding eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy are covered. The device must be among those that the Food and Drug Administration has approved for general use. If two or more types of medically appropriate devices are available, Health Net will determine which device or appliance will be covered. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. Organ, tissue and stem cell transplants that are not Experimental or Investigational are covered if the transplant is authorized under SELECT 1 or precertified under SELECT 2 by Health Net and performed at a Health Net Transplant Performance Center. Health Net has a specific network of designated Transplant Performance Centers to perform organ, tissue and stem cell transplants. Your Member Physician can provide you with information about our Transplant Performance Centers. You will be directed to a designated Health Net Transplant Performance Center at the time authorization or precertification is obtained. Preferred Providers that are not designated as part of Health Net\u2019s network of Transplant Performance Centers are considered Out-of-Network Providers for purposes of determining coverage and benefits for transplants and transplant-related services. Medically Necessary services, in connection with an organ, stem cell or tissue transplant are covered as follows: \u2022 For the enrolled Member who receives the transplant; and \u2022 For the Donor (whether or not an enrolled Member). Benefits are reduced by any amounts paid or payable by the donor\u2019s own coverage. Only Medically Necessary services related to the organ donation are covered. Evaluation of potential candidates is subject to prior authorization. More than one evaluation (including tests) at more than one transplant center will not be authorized unless it is Medically Necessary. Organ donation extends and enhances lives and is an option that you may want to consider. For more information on organ donation, including how to elect to be an organ donor, please contact the Customer Contact Center at the telephone number on your Health Net ID Card, or visit the Department of Health and Human Services organ donation website at \u2587\u2587\u2587.\u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587.\u2587\u2587\u2587. Charges for reasonable and appropriate computer searches for acceptable organs and tissues are not covered under SELECT 2. Travel expenses and hotel accommodations associated with organ, tissue and stem cell transplants are not covered. A limited Chiropractic benefit is available. Expenses related to or connected with the detection or correction by manual or mechanical means of structural imbalance, distortion or subluxation; where such care is for the purpose of removing nerve interference and its effects and where interference is the result of or related to distortion, misalignment or subluxation of or in the spinal column. Chiropractic Services and Supplies are limited by a number of visits indicated in the \"Schedule of Benefits and Copayments - SELECT 2 and SELECT 3\" sections.", "hash": "994735f1711fdaf44d684d37ddcc76f0", "id": 6}, {"size": 2, "snippet_links": [{"key": "body-part", "type": "definition", "offset": [55, 64]}, {"key": "surgically-implanted", "type": "clause", "offset": [108, 128]}, {"key": "visual-aids", "type": "clause", "offset": [192, 203]}, {"key": "assist-the", "type": "clause", "offset": [227, 237]}, {"key": "visually-impaired", "type": "clause", "offset": [238, 255]}, {"key": "in-addition", "type": "clause", "offset": [359, 370]}, {"key": "medically-necessary", "type": "definition", "offset": [411, 430]}, {"key": "health-net", "type": "definition", "offset": [455, 465]}, {"key": "physician-group", "type": "definition", "offset": [474, 489]}, {"key": "the-provider", "type": "definition", "offset": [502, 514]}, {"key": "the-items", "type": "definition", "offset": [529, 538]}, {"key": "types-of", "type": "clause", "offset": [555, 563]}, {"key": "medically-appropriate", "type": "clause", "offset": [564, 585]}, {"key": "contracting-physician", "type": "definition", "offset": [641, 662]}, {"key": "the-device", "type": "clause", "offset": [727, 737]}, {"key": "food-and-drug-administration", "type": "definition", "offset": [767, 795]}, {"key": "for-general-use", "type": "definition", "offset": [809, 824]}, {"key": "repair-or-replacement", "type": "definition", "offset": [890, 911]}, {"key": "for-loss", "type": "clause", "offset": [912, 920]}, {"key": "not-covered", "type": "definition", "offset": [934, 945]}, {"key": "replace-or-repair", "type": "clause", "offset": [981, 998]}, {"key": "right-to-request", "type": "clause", "offset": [1021, 1037]}, {"key": "your-primary-care-physician", "type": "clause", "offset": [1063, 1090]}, {"key": "referral-physician", "type": "definition", "offset": [1096, 1114]}, {"key": "treatment-plan", "type": "clause", "offset": [1149, 1163]}, {"key": "loss-of-life", "type": "clause", "offset": [1363, 1375]}, {"key": "bodily-function", "type": "definition", "offset": [1385, 1400]}, {"key": "not-limited", "type": "clause", "offset": [1444, 1455]}, {"key": "test-results", "type": "definition", "offset": [1587, 1599]}, {"key": "contact-center", "type": "clause", "offset": [1728, 1742]}, {"key": "in-accordance-with", "type": "definition", "offset": [1818, 1836]}, {"key": "procedures-and-timelines", "type": "clause", "offset": [1850, 1874]}, {"key": "second-opinion-policy", "type": "clause", "offset": [1892, 1913]}, {"key": "a-copy-of", "type": "clause", "offset": [1930, 1939]}, {"key": "this-policy", "type": "definition", "offset": [1940, 1951]}, {"key": "second-opinions", "type": "clause", "offset": [2010, 2025]}, {"key": "associated-with", "type": "definition", "offset": [2126, 2141]}, {"key": "the-request", "type": "clause", "offset": [2142, 2153]}], "samples": [{"hash": "2XYq4nSJ7sF", "uri": "/contracts/2XYq4nSJ7sF#prostheses", "label": "Group Hospital and Professional Service Agreement", "score": 23.1902809143, "published": true}], "snippet": "Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgically implanted hip joints, devices to restore speaking after laryngectomy and visual aids (excluding Eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy are covered. Health Net or your Physician Group will select the provider or vendor for the items. If two or more types of medically appropriate devices or appliances are available, Health Net or the contracting Physician Group will determine which device or appliance will be covered. The device must be among those that the Food and Drug Administration has approved for general use. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. You have the right to request a second opinion when: \u2022 Your Primary Care Physician or a referral Physician gives a diagnosis or recommends a treatment plan, that you are not satisfied with; \u2022 You are not satisfied with the result of treatment you have received; \u2022 You are diagnosed with, or a treatment plan is recommended for, a condition that threatens loss of life, limb or bodily function or a substantial impairment, including but not limited to a Serious Chronic Condi- tion; or \u2022 Your Primary Care Physician or a referral Physician is unable to diagnose your condition or test results are conflicting. To request an authorization for a second opinion, contact your Primary Care Physician or Health Net\u2019s Customer Contact Center. Physicians at your Physician Group or Health Net will review your request in accordance with Health Net\u2019s procedures and timelines as stated in the second opinion policy. You may obtain a copy of this policy from Health Net\u2019s Customer Contact Center. All authorized second opinions must be provided by a Physician who has training and expertise in the illness, disease or condition associated with the request.", "hash": "dd507e4d5ad6e1e8d9c9e805cbb1192b", "id": 7}, {"size": 2, "snippet_links": [{"key": "cost-of", "type": "clause", "offset": [3, 10]}, {"key": "inclusive-of", "type": "clause", "offset": [25, 37]}, {"key": "wherever-required", "type": "clause", "offset": [53, 70]}, {"key": "the-materials", "type": "definition", "offset": [120, 133]}, {"key": "bureau-of-indian-standards", "type": "definition", "offset": [144, 170]}, {"key": "replacement-guarantee", "type": "definition", "offset": [285, 306]}, {"key": "replacement-of", "type": "clause", "offset": [343, 357]}, {"key": "general-guidelines", "type": "clause", "offset": [449, 467]}, {"key": "in-order-to", "type": "clause", "offset": [468, 479]}, {"key": "service-providers", "type": "definition", "offset": [522, 539]}, {"key": "the-trust", "type": "clause", "offset": [566, 575]}, {"key": "network-hospitals", "type": "definition", "offset": [602, 619]}, {"key": "the-meeting", "type": "clause", "offset": [709, 720]}, {"key": "core-committee", "type": "definition", "offset": [724, 738]}, {"key": "the-committee", "type": "clause", "offset": [773, 786]}, {"key": "based-on", "type": "definition", "offset": [920, 928]}, {"key": "hospital-services", "type": "definition", "offset": [994, 1011]}, {"key": "in-network", "type": "clause", "offset": [1046, 1056]}, {"key": "bed-capacity", "type": "definition", "offset": [1143, 1155]}, {"key": "for-treatment", "type": "clause", "offset": [1204, 1217]}], "samples": [{"hash": "4HpbzIuoJZ9", "uri": "/contracts/4HpbzIuoJZ9#prostheses", "label": "Memorandum of Understanding", "score": 19.3709793091, "published": true}], "snippet": "i) Cost of prosthesis is inclusive of foot and shoe, wherever required.\nii) Prosthesis must have been manufactured with the materials with BIS (Bureau of Indian Standards) certification.\niii) All prosthesis shall be functional in nature.\niv) Manufacturer shall give minimum of 3 years replacement Guarantee.\nv) Manufacturer shall provide free replacement of leather parts/straps etc., during this period apart from replacement guarantee. ANNEXURE-V GENERAL GUIDELINES In order to obtain feedback on Aarogyasri-I & II from service providers and resolve issues if any the Trust conducted a workshop with Network Hospitals on Rajiv Aarogyasri on 08.09.2008 .Representatives of the 319 Network Hospitals attended the meeting. A Core committee was formed after the workshop and the Committee met on 19.9.2008 and discussed the points raised in the workshop. Trust approved the following recommendations made by the Committee based on feasibility and benefit that will accrue to the BPL families.\nA. HOSPITAL SERVICES\ni) Allocating minimum 25% of beds in network hospitals for Aarogyasri patients: Network hospitals should make atleast 25% of their bed capacity available for occupation by Aarogyasri patients for treatment.", "hash": "a90f2155610083eeece87f5d39ed5ad0", "id": 8}, {"size": 1, "snippet_links": [{"key": "part-of-the-body", "type": "definition", "offset": [48, 64]}, {"key": "defective-parts", "type": "clause", "offset": [82, 97]}], "samples": [{"hash": "3QAhYXlW6KR", "uri": "/contracts/3QAhYXlW6KR#prostheses", "label": "Health Care Plan Rules", "score": 19.6885700226, "published": true}], "snippet": "An artificial extension that replaces a missing part of the body or sup- plements defective parts.", "hash": "ccd425741e5e6c29a0748e61f998405e", "id": 9}, {"size": 1, "snippet_links": [{"key": "body-part", "type": "definition", "offset": [55, 64]}, {"key": "visual-aids", "type": "clause", "offset": [196, 207]}, {"key": "assist-the", "type": "clause", "offset": [231, 241]}, {"key": "visually-impaired", "type": "clause", "offset": [242, 259]}, {"key": "in-addition", "type": "clause", "offset": [363, 374]}, {"key": "medically-necessary", "type": "definition", "offset": [415, 434]}, {"key": "for-members", "type": "clause", "offset": [714, 725]}, {"key": "tube-feeding", "type": "definition", "offset": [738, 750]}, {"key": "in-accordance-with", "type": "definition", "offset": [762, 780]}, {"key": "health-net", "type": "definition", "offset": [802, 812]}, {"key": "the-member", "type": "clause", "offset": [816, 826]}, {"key": "physician-group", "type": "definition", "offset": [829, 844]}, {"key": "the-provider", "type": "definition", "offset": [857, 869]}, {"key": "the-items", "type": "definition", "offset": [884, 893]}, {"key": "types-of", "type": "clause", "offset": [910, 918]}, {"key": "medically-appropriate", "type": "clause", "offset": [919, 940]}, {"key": "the-device", "type": "clause", "offset": [1070, 1080]}, {"key": "for-general-use", "type": "definition", "offset": [1154, 1169]}, {"key": "repair-or-replacement", "type": "definition", "offset": [1235, 1256]}, {"key": "for-loss", "type": "clause", "offset": [1257, 1265]}, {"key": "not-covered", "type": "definition", "offset": [1279, 1290]}, {"key": "replace-or-repair", "type": "clause", "offset": [1326, 1343]}, {"key": "as-shown", "type": "definition", "offset": [1376, 1384]}, {"key": "medical-supplies", "type": "clause", "offset": [1392, 1408]}, {"key": "benefits-and-copayments", "type": "clause", "offset": [1426, 1449]}, {"key": "section-200", "type": "clause", "offset": [1452, 1463]}, {"key": "blood-transfusions", "type": "clause", "offset": [1465, 1483]}, {"key": "cost-of", "type": "clause", "offset": [1517, 1524]}, {"key": "blood-and-blood-products", "type": "clause", "offset": [1543, 1567]}, {"key": "covered-services-include", "type": "clause", "offset": [1736, 1760]}, {"key": "the-hospital", "type": "definition", "offset": [1829, 1841]}, {"key": "room-rate", "type": "definition", "offset": [1869, 1878]}, {"key": "furnishings-and-equipment", "type": "clause", "offset": [1894, 1919]}, {"key": "special-diets", "type": "clause", "offset": [1931, 1944]}, {"key": "care-units", "type": "definition", "offset": [1992, 2002]}, {"key": "private-rooms", "type": "clause", "offset": [2006, 2019]}, {"key": "physician-services", "type": "definition", "offset": [2048, 2066]}, {"key": "critical-care", "type": "clause", "offset": [2085, 2098]}, {"key": "nursing-care", "type": "definition", "offset": [2109, 2121]}, {"key": "special-duty", "type": "clause", "offset": [2124, 2136]}, {"key": "special-treatment", "type": "clause", "offset": [2196, 2213]}, {"key": "ancillary-services", "type": "definition", "offset": [2236, 2254]}, {"key": "professional-component", "type": "definition", "offset": [2318, 2340]}, {"key": "respiratory-therapy", "type": "clause", "offset": [2397, 2416]}, {"key": "radiation-therapy", "type": "definition", "offset": [2420, 2437]}, {"key": "renal-dialysis-treatment", "type": "definition", "offset": [2456, 2480]}, {"key": "rehabilitative-services", "type": "clause", "offset": [2518, 2541]}, {"key": "radioactive-materials", "type": "definition", "offset": [2577, 2598]}, {"key": "medical-equipment-and-supplies", "type": "clause", "offset": [2644, 2674]}, {"key": "medical-social-services", "type": "definition", "offset": [2678, 2701]}, {"key": "food-and-drug-administration", "type": "definition", "offset": [2756, 2784]}, {"key": "during-your-stay", "type": "clause", "offset": [2828, 2844]}, {"key": "discharge-planning", "type": "clause", "offset": [3096, 3114]}, {"key": "the-planning", "type": "clause", "offset": [3125, 3137]}, {"key": "continuing-care", "type": "clause", "offset": [3146, 3161]}, {"key": "professional-services", "type": "definition", "offset": [3262, 3283]}, {"key": "services-and", "type": "clause", "offset": [3314, 3326]}, {"key": "outpatient-surgery", "type": "definition", "offset": [3327, 3345]}, {"key": "outpatient-surgical-center", "type": "definition", "offset": [3373, 3399]}, {"key": "services-performed", "type": "clause", "offset": [3426, 3444]}, {"key": "department-of", "type": "clause", "offset": [3463, 3476]}, {"key": "not-limited", "type": "clause", "offset": [3503, 3514]}, {"key": "speech-therapy", "type": "clause", "offset": [3603, 3617]}, {"key": "pulmonary-rehabilitation-therapy", "type": "clause", "offset": [3619, 3651]}, {"key": "cardiac-rehabilitation-therapy", "type": "definition", "offset": [3653, 3683]}, {"key": "laboratory-tests", "type": "clause", "offset": [3685, 3701]}, {"key": "subject-to-the", "type": "clause", "offset": [3750, 3764]}, {"key": "your-physician", "type": "clause", "offset": [3835, 3849]}, {"key": "surgery-center", "type": "definition", "offset": [3918, 3932]}, {"key": "refer-to", "type": "clause", "offset": [4032, 4040]}, {"key": "outpatient-hospital-services", "type": "definition", "offset": [4042, 4070]}, {"key": "for-more-information", "type": "clause", "offset": [4126, 4146]}, {"key": "reconstructive-surgery", "type": "definition", "offset": [4148, 4170]}, {"key": "to-restore-and-achieve-symmetry", "type": "definition", "offset": [4171, 4202]}, {"key": "caused-by", "type": "clause", "offset": [4286, 4295]}, {"key": "to-the-extent", "type": "clause", "offset": [4466, 4479]}, {"key": "cosmetic-surgery", "type": "clause", "offset": [4598, 4614]}, {"key": "in-order-to", "type": "clause", "offset": [4683, 4694]}, {"key": "dental-services", "type": "definition", "offset": [4717, 4732]}, {"key": "set-out", "type": "definition", "offset": [4793, 4800]}, {"key": "exclusions-and-limitations", "type": "definition", "offset": [4865, 4891]}, {"key": "orthodontic-services", "type": "definition", "offset": [4971, 4991]}, {"key": "integral-part", "type": "definition", "offset": [5004, 5017]}, {"key": "cleft-palate", "type": "definition", "offset": [5048, 5060]}, {"key": "craniofacial-anomalies", "type": "definition", "offset": [5128, 5150]}, {"key": "associated-with", "type": "definition", "offset": [5151, 5166]}, {"key": "contracting-physician", "type": "definition", "offset": [5200, 5221]}, {"key": "determine-the", "type": "clause", "offset": [5228, 5241]}, {"key": "related-to", "type": "clause", "offset": [5326, 5336]}, {"key": "lymph-node", "type": "definition", "offset": [5379, 5389]}, {"key": "prior-authorization", "type": "definition", "offset": [5452, 5471]}, {"key": "length-of-stay", "type": "definition", "offset": [5492, 5506]}, {"key": "incident-to", "type": "definition", "offset": [5589, 5600]}], "samples": [{"hash": "ffPkKe8oj06", "uri": "/contracts/ffPkKe8oj06#prostheses", "label": "Group Hospital and Professional Service Agreement", "score": 25.8369293213, "published": true}], "snippet": "Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgi- cally implanted hip joints, devices to restore speaking after a laryngectomy and visual aids (excluding eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy (including lumpectomy), and prostheses to restore symmetry and treat complications, including lymphedema, are covered. Lymphedema wraps and garments are covered, as well as up to three brassieres in a 12 month period to hold a prostheses. In addition, enteral formula for members who require tube feeding is covered in accordance with Medicare guidelines. Health Net or the Member's Physician Group will select the provider or vendor for the items. If two or more types of medically appropriate devices or appliances are available, Health Net or the Physician Group will determine which device or appliance will be covered. The device must be among those that the Food and Drug Administra- tion has approved for general use. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. Prostheses are covered as shown under \"Medical Supplies\" in \"Schedule of Benefits and Copayments,\" Section 200. Blood transfusions, including blood processing, the cost of blood, unreplaced blood and blood products, are covered. However, self-donated (autologous) blood transfusions are covered only for a surgery that the contract- ing Physician Group has authorized and scheduled. Covered services include: \u2022 Accommodations as an inpatient in a room of two or more beds, at the Hospital's most common semi-private room rate with customary furnishings and equipment (including special diets as Medically Necessary); \u2022 Services in Special Care Units; \u2022 Private rooms, when Medically Necessary \u2022 Physician services \u2022 Specialized and critical care \u2022 General nursing care \u2022 Special duty nursing as Medically Necessary); \u2022 Operating, delivery and special treatment rooms; \u2022 Supplies and ancillary services including laboratory, cardiology, pathology, radiology and any professional component of these services; \u2022 Physical, speech, occupational and respiratory therapy; \u2022 Radiation therapy, chemotherapy and renal dialysis treatment; \u2022 Other diagnostic, therapeutic and rehabilitative services, as appropriate; \u2022 Biologicals and radioactive materials; \u2022 Anesthesia and oxygen services, \u2022 Durable Medical Equipment and supplies; \u2022 Medical social services \u2022 Drugs and medicines approved for general use by the Food and Drug Administration which are supplied by the Hospital for use during Your stay; \u2022 Blood transfusions, including blood processing, the cost of blood and unreplaced blood and Blood Products are covered. Self-donated (autologous) blood transfusions are covered only for a scheduled surgery that has been certified; and \u2022 Coordinated discharge planning including the planning of such continuing care as may be necessary, both medically and as a means of preventing possible early re-hospitalization. Professional services, outpatient Hospital facility services and outpatient surgery performed in a Hospital or Outpatient Surgical Center are covered. Professional services performed in the outpatient department of a Hospital (including but not limited to a visit to a Physician, rehabilitation therapy, including physical, occupational and speech therapy, pulmonary rehabilitation therapy, cardiac rehabilitation therapy, laboratory tests, x-ray, radiation therapy and chemotherapy) are subject to the same Copayment which is required when these services are performed at your Physician Group. Copayments for surgery performed in a Hospital or outpatient surgery center may be different than Copayments for professional or outpatient Hospital facility services. Please refer to \"Outpatient Hospital Services\" in \"Schedule of Benefits and Copayments,\" Section 200 for more information. Reconstructive surgery to restore and achieve symmetry including surgery performed to correct or repair abnor- mal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease, to do either of the following: \u2022 Improve function; or \u2022 Create a normal appearance to the extent possible, unless the surgery offers only a minimal improvement in the appearance of the Member. This does not include cosmetic surgery that is performed to alter or reshape normal structures of the body in order to improve appearance or dental services or supplies or treatment for disorders of the jaw except as set out under \"Dental Services\" and \"Disorders of the Jaw\" portions of \"Exclusions and Limitations,\" Section 600. Reconstruc- tive surgery includes Medically Necessary dental or orthodontic services that are an integral part of reconstructive surgery for cleft palate procedures. Cleft palate includes cleft palate, cleft lip or other craniofacial anomalies associated with cleft palate. Health Net and the contracting Physician Group determine the feasibility and extent of these services, except that, the length of Hospital stays related to mastectomies (including lumpectomies) and lymph node dissections will be determined solely by the Physician and no Prior Authorization for determining the length of stay is required. This includes reconstructive surgery to restore and achieve symmetry incident to mastectomy.", "hash": "0c2f9ef6d890b9456162a9d41e3c9eb9", "id": 10}], "next_curs": "ClMSTWoVc35sYXdpbnNpZGVyY29udHJhY3Rzci8LEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IhNwcm9zdGhlc2VzIzAwMDAwMDBhDKIBAmVuGAAgAA==", "clause": {"title": "Prostheses", "parents": [["tuberculosis-screening", "Tuberculosis Screening"], ["tobacco-smoking-cessation", "Tobacco/Smoking Cessation"], ["circulars-notifications", "Circulars / Notifications"], ["compliance-with-empanelment-criteria", "Compliance with Empanelment Criteria"], ["role-of-district-administration-in-conducting-the-camps", "ROLE OF DISTRICT ADMINISTRATION IN CONDUCTING THE CAMPS"]], "size": 39, "children": [["follow-up-services-to-aarogyasri-patients", "Follow-up services to Aarogyasri Patients"], ["", ""], ["conduct-of-health-camps", "Conduct of Health Camps"], ["medical", "MEDICAL"], ["conduct-of-op-services", "Conduct of OP services"]], "id": "prostheses", "related": [["prosthodontics", "Prosthodontics", "Prosthodontics"], ["screening", "Screening", "Screening"], ["orthodontics", "Orthodontics", "Orthodontics"], ["medication", "Medication", "Medication"], ["speech-therapy", "Speech Therapy", "Speech Therapy"]], "related_snippets": [], "updated": "2025-07-10T04:27:38+00:00"}, "json": true, "cursor": ""}}