Reconstructive Surgery Benefits Sample Clauses

Reconstructive Surgery Benefits. Benefits are available for Reconstructive Surgery services. Benefits include: • Surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to: o Improve function; or o Create a normal appearance to the extent possible; • Dental and orthodontic surgery services directly related to cleft palate repair; and • Surgery and surgically-implanted prosthetic devices in accordance with the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Benefits do not include: • Cosmetic surgery, which is surgery that is performed to alter or reshape normal structures of the body to improve appearance; • Reconstructive Surgery when there is a more appropriate procedure that will be approved; or • Reconstructive Surgery to create a normal appearance when it offers only a minimal improvement in appearance. In accordance with the WHCRA, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered for either breast to restore and achieve symmetry following a mastectomy, and for the treatment of the physical complications of a mastectomy, including lymphedemas. For coverage of prosthetic devices following a mastectomy, see the Durable medical equipment section. Medically Necessary services will be determined by your attending Physician in consultation with you. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons, except as required under the WHCRA.
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function, or (2) to create a normal appearance to the extent possible. Benefits include dental and orthodontic services that are an integral part of this surgery for cleft palate procedures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. In accordance with the Women’s Health & Cancer Rights Act, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered on either breast to restore and achieve symmetry incident to a mastectomy, and treatment of physical complications of a mastectomy, including lymphedemas. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons. Rehabilitation and Habilitation Services Benefits (Physical, Occupational and Respiratory Therapy) Benefits are provided for outpatient Physical, Occupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records for Medical Necessity. Benefits for Speech Therapy are described in the Speech Therapy Benefits section. See the Home Health Care Benefits and Hospice Program Benefits sections for information on coverage for Rehabilitation/Habilitation services rendered in the home. Skilled Nursing Facility Benefits Benefits are provided for Skilled Nursing services in a Skilled Nursing unit of a Hospital or a free- standing Skilled Nursing Facility, up to the Benefit maximum as shown on the Summary of Benefits. The Benefit maximum is per Member per Benefit Period, except that room and board charges in excess of the facility’s established semi-private room rate are excluded. A “Benefit Period” begins on the date the Member is admitted into the facility for Skilled Nursing services, and ends 60 days after being discharged and Skilled Nursing services are no longer being received. A new Benefit Period can begin only after an existing Benefit Period ends. Speech Therapy Benefits Benefits are provided for Medically Necessary outpatient Speech Therapy servic...
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function, or (2) to create a normal appearance to the extent possible. Benefits include dental and orthodontic services that are an integral part of this surgery for cleft palate procedures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. In accordance with the Women’s Health & Cancer Rights Act, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered on either breast to restore and achieve symmetry incident to a mastectomy, and treatment of physical complications of a mastectomy, including lymphedemas. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons. Rehabilitation and Habilitation Services Benefits (Physical, Occupational and Respiratory Therapy) Benefits are provided for outpatient Physical, Occupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records. Services provided by a chiropractor are not included in this Rehabilitation/Habilitation benefit. Benefits for Speech Therapy are described in the Speech Therapy Benefits section.
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tu- mors, or disease to do either of the following to:
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital de- fects, developmental abnormalities, trauma, infec- tion, tumors, or disease to do either of the follow- ing: (1) to improve function, or (2) to create a nor- mal appearance to the extent possible. Benefits in- clude dental and orthodontic services that are an integral part of this surgery for cleft palate proce- dures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. In accordance with the Women’s Health & Cancer Rights Act, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered on either breast to restore and achieve symmetry inci- dent to a mastectomy, and treatment of physical complications of a mastectomy, including lym- phedemas. Benefits will be provided in accordance with guidelines established by Blue Shield and devel- oped in conjunction with plastic and reconstructive surgeons. Rehabilitation and Habilitation Services Benefits (Physical, Occupational and Respiratory Therapy) Benefits are provided for outpatient Physical, Oc- cupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records for Medi- cal Necessity. Benefits for Speech Therapy are described in the Speech Therapy Benefits section.
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Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function, or (2) to create a normal appearance to the extent possible. Benefits include dental and orthodontic services that are an integral part of this surgery for cleft palate procedures. Reconstructive Surgery is covered to create a normal appearance only when it offers more than a minimal improvement in appearance. Rehabilitation and Habilitation Services Benefits (Physical, Occupational and Respiratory Therapy) Benefits are provided for outpatient Physical, Occupational, and Respiratory Therapy pursuant to a written treatment plan, and when rendered in the provider’s office or outpatient department of a Hospital. Blue Shield reserves the right to periodically review the provider’s treatment plan and records. Services provided by a chiropractor are not included in this Rehabilitation/Habilitation benefit. Benefits for Speech Therapy are described in the Speech Therapy Benefits section.
Sample 1
Reconstructive Surgery Benefits. Benefits are provided to correct or repair abnormal Benefits for Speech Therapy are described in the Speech Therapy Benefits (Rehabilitation and Habil- itative Services) section. See the Home Health Care Benefits and Hospice Program Benefits sections for information on cov- erage for Rehabilitation services rendered in the home. structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tu- mors, or disease to do either of the following to:
Sample 1
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Related to Reconstructive Surgery Benefits

  • Dependent Child If dependent children are covered under separate plans of more than one person, whether a parent or guardian, benefits for the child will be determined in the following order: • the benefits of the plan covering the parent born earlier in the year will be determined before those of the parent whose birthday (month and day only) falls later in the year; • if both parents have the same birthday, the benefits of the plan that covered the parent longer are determined before those of the plan which covered the other parent for a shorter period of time; • if the other plan does not determine benefits according to the parents' birth dates, but by parents' gender instead, the other plan’s gender rule will determine the order of benefits.

  • Dental Benefits The County offers dental and orthodontic benefits to full and part-time regular employees and their eligible dependent(s). Benefit provisions, co­ payments and deductibles are outlined in the Evidence of Coverage. The employee contribution is $13 per pay period ($28.26 per month). The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Retiree Medical Benefits If Executive is or would become fifty-five (55) or older and Executive's age and service equal sixty-five (65) and Executive has at least five (5) years of service with the Company within two (2) years of Change in Control, Executive is eligible for retiree medical benefits (as such are determined immediately prior to Change in Control). Executive is eligible to commence receiving such retiree medical benefits based on the terms and conditions of the applicable plans in effect immediately prior to the Change in Control.

  • Dependent Care The College will make available to employees, at their option, an Internal Revenue Service Code Section 129 Dependent Care plan. The plan will be established, administered, and communicated to employees by the State without cost to the employees.

  • Dependent Child/Parents Separated or Divorced If two or more plans cover a person as a dependent child of divorced or separated parents, the plan responsible to cover benefits for the child will be determined in the following order: • first, the plan of the parent with custody of the child; • then, the plan of the spouse of the parent with custody of the child; and • finally, the plan of the parent not having custody of the child. If the terms of a court decree state that: • one of the parents is responsible for the healthcare expenses of the child, and the entity obligated to pay or provide the parent's benefits under that parent's plan has actual knowledge of those terms, the benefits of that plan are determined first and the benefits of the plan of the other parent are the secondary plan. • both parents share joint custody, without stating that one of the parents is responsible for the healthcare expenses of the child, the plans covering the child will follow the order of benefit determination rules outlined above.

  • Change in Employment Status In the event that a Participant who was credited with a year of Service for the preceding Plan Year, at the request of the Employer, enters directly into the employ of any other business entity, such Participant shall be deemed to be an Active Participant. If such Participant returns to the employ of the Employer or becomes eligible for benefits pursuant to Articles V, VI or VII, without interruption of employment with the Employer or other business entity, he shall be deemed not to have had a Service Break for such period. However, if such Participant does not immediately return to the employ of the Employer upon his termination of employment with such other business entity or upon recall by the Employer, he shall be deemed to have terminated his employment for all purposes of the Plan as of the Anniversary Date following the date of transfer.

  • Membership Benefits The benefits of CamCare programs are available only while your membership is current and active. Benefits are term year specific so they can only be used during the current active plan agreement period. Members have the ability to change their plan from one plan to another but the plans cannot be unbundled. Each plan has been designed carefully to include those elements associated with the main intent of a particular plan.

  • Project Employment 1. The Employer may appoint employees into project positions for which employment is contingent upon state, federal, local, grant, or other special funding of specific and of time-limited duration. The Employer will notify the employees, in writing, of the expected ending date of the project employment.

  • Plan Benefits Each year, prior to the annual enrollment period, EMPLOYEES will receive Enrollment information that will outline the benefits offered next calendar year. Information relative to specific health insurance benefits and limitations will be updated regularly and contained in the SPD. In the event there is a conflict between the provisions of the collective bargaining agreement and the SPD, the District's SPD shall control.

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