Services Not Covered. This service contract does not cover service, maintenance, repair, or replacement necessitated by any loss or damage occurring prior to the issuance of this service contract and resulting from (1) any cause other than normal usage, such as, but not limited to loss or damage due to misuse, abuse, neglect; (2) unauthorized repair by others; (3) lack of manufacturer’s recommended maintenance; (4) any commercial use or use other than that of a personal, domestic, or household nature unless otherwise selected on Schedule Page; (5) inherent design defect in the product; (6) rust, corrosion, insect infestation, fire, water, windstorm, hail, earthquake, theft or burglary, negligence, vandalism, transport, riot, environmental conditions, sand, dirt, damage from exposure to weather conditions, any intentional acts caused by You, power reductions or fluctuations, lightning, flood, malicious mischief, civil commotion, arson or explosion. IN NO EVENT SHALL THIS SERVICE CONTRACT BE LIABLE FOR SPECIAL, INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES WHETHER IN CONTRACT, TORT, OR NEGLIGENCE. This service contract does not cover claims arising from any breach of implied or expressed warranty of merchantabililty or fitness of the product from the manufacturer. This service contract does not cover repair or replacement caused by defects that existed prior to this contract purchase.
Services Not Covered. The Parties recognize that the Contractor may provide services to Sellers beyond those covered in Sections B.1 and B.2 of this Contract. These may include, but are not limited to:
Services Not Covered a. Behavioral Health Services Contractors will not be responsible for coverage of behavioral health services. Behavioral health services are defined as any inpatient or residential treatment for mental disorders; any outpatient hospital mental health treatment (revenue codes 90X and 91X or procedure codes 908XX); any procedure using procedure code 908XX; other mental health services using HCPCS codes for programs described in Medicaid Policy Sections 15 or 21; and any service outlined in the approved waivers for IDDD or SED (MYPAC). The Contractor will be responsible for coverage of all drugs, including psychotropic drugs, for Members as many of these medicines are prescribed by primary care physicians.
Services Not Covered. The plan does not cover the following services: ➢ services that are not routinely performed by a dentist or denturist;. ➢ services that are not reasonable or necessary to maintain or restore teeth; ➢ services for which any benefits are payable under Workers' Compensation or any publicly supported plans; ➢ services not included in the dental or denturist fee schedules; ➢ services required because of war, riot, or self-inflicted injury, while sane or insane; ➢ services required because of participation in, attempt or commission of a criminal act; ➢ temporary dentistry, oral hygiene instruction, tissue grafts, services purely cosmetic in nature or used to correct congenital malformations; ➢ drug or medicines; ➢ services related to the functioning or structure of the jaw, jaw muscles or temporo mandibular joint; ➢ implants; ➢ replacement of lost or stolen orthodontia appliances; ➢ charges for appointments not kept; ➢ charges resulting from a change of dentist or denturist, unless approved by the plan carrier; ➢ charges for completing forms; ➢ charges for work in progress at the time the coverage for you and your dependents is terminated.
Services Not Covered. Services purely cosmetic in nature, or for purely cosmetic reasons. • Charges for broken appointments. • Services covered or provided through Workers’ Compensation legislation, any government agency, or a third party liability. • Congenital malformations, e.g. cleft palate prosthesis (if included in this Proposal). • Major dental services including inlays, crowns, bridges, full dentures, partial dentures, including facings on crowns or pontics (false teeth) more often than once every five (5) years. • Fees arising out of extra services arranged for privately between the patient and the dentist. • Implants. • Oral hygiene instruction. • Plaque control programs. • Charges for completing claim forms.
Services Not Covered. Dental care benefits are not payable for prescription drugs, hospital charges except for those items listed as eligible expenses, charges of an anesthetist or anesthesiologist while the insured is hospitalized, those services provided for under the Alberta Health Insurance Act or other government legislation, services eligible for payment from another source such as Workers' Compensation, a government agency or any other insurer, expenses incurred principally for cosmetic purposes, expenses resulting from an act of war, or any service for which an employee or dependent does not have to pay.
Services Not Covered. An employee or dependent shall not be eligible for and no amount will be payable for any procedures resulting from any of the following: Resulting from illness or injury for which the employee or dependent is entitled to benefit under the Compensation Act or similar law, or Which was not recommended and approved by a physician
Services Not Covered. This service contract does not cover service, maintenance, repair, or replacement necessitated by any loss or damage occurring prior to the issuance of this service contract and resulting from (1) any cause other than normal usage, such as, but not limited to loss or damage due to misuse, abuse, neglect; (2) unauthorized repair by others;
Services Not Covered. Items not included in the fees set forth in this Agreement for "Standard Services" Section B such as payment of stock dividends or splits or any other services associated with a special project will be billed separately on an appraisal basis. Services required by legislation or regulatory fiat which become effective after the date of this Agreement shall not be a part of the Standard Services and shall be billed by appraisal. All out-of-pocket expenses such as telephone line charges associated with toll free telephone calls, overprinting, insurance, stationary, envelopes, telecopy charges, excess material storage and disposal will be billed to Zweix xx incurred.
Services Not Covered. The staff at TH PACE of Pensacola promises to give you the very best care possible. There are some things staff cannot do for you. Below is a list of services TH PACE of Pensacola will not pay for: • Cosmetic surgery, unless required for improved functioning of a malformed part of the body resulting from an accidental injury, or for reconstruction following mastectomy. • Experimental medical, surgical, or other health procedures. • Any services given outside of the United States, except in certain emergency situations. GENERAL PROVISIONS Continuation of Services on Termination: Trinity Health PACE of Pensacola has an agreement with CMS and the Florida Agency for Health Care Administration (ACHA) that requires periodic renewal. If our agreement with CMS and the Florida Agency for Health Care Administration (ACHA) not renewed or discontinued for any reason, the program will be terminated. If this happens, you will continue to be entitled to coverage under Medicare Parts A and B and/or Medicaid and we will transition your care to other providers in your community. Cooperation in Assessments: In order for us to determine the best services for you, your full cooperation is required in providing us with medical and financial information. Governing Law: TH PACE of Pensacola is subject to the requirements of the Florida Agency for Health Care Administration and the U. S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). Any provision required to be in this agreement shall bind TH PACE of Pensacola, whether or not it is specifically included in this document. No Assignment: You cannot assign any benefits or payments due under this agreement to any person, corporation, or other organization. Any assignment by you will be void. Assignment means the transfer to another person or organization of your right to the services provided under this plan or your right to collect money from us for those services.
