Surgical Benefits Sample Clauses

Surgical Benefits. (a) Doctor's bill will be paid fo gical operations according to a standard "Sched­ ule of Operations" as set forth in the insurance certificate, maximum payment $350.00.
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Surgical Benefits. The Contractor shall cover Behavioral Health Benefits in a manner that is no more restrictive than the coverage for Medical/Surgical Benefits. Attachment A, “Schedule of In-Plan Benefits” identifies the types and amount, duration, and scope of services and is consistent with EOHHS’ parity analysis. The Contractor may cover additional services necessary to comply with the requirements for parity in Behavioral Health Benefits in 42 C.F.R. Part 438, Subpart K; however, the Contractor must provide advance written notice to and receive prior written approval from the EOHHS Managed Care Director when it believes this requirement is triggered. The Contractor shall not:
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Surgical Benefits. 3. Major medical benefits. The Board reserves the right to change the carrier. However, the benefits under a new carrier must be at least equal to those of the State Health Benefit Program. The Board shall provide a Prescription Drug Program covering employee, spouse and family. Such program shall be with a $10.00 deductible co-insurance feature for non-generic drugs and a $5.00 deductible co-insurance feature for generic drugs, and a $0 feature for mail-in refills. The Board shall provide a Dental Program with coverage equal to or better than coverage under the prior agreement. The coverage shall include 90/10 co-insurance provision with a zero deductible. This program shall cover employee and dependents. Orthodontic coverage shall continue a 50-50 split, but to a maximum of Two Thousand Dollars ($2,000.00). Orthodontic shall include adult coverage.
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Surgical Benefits. The Plan pays charges for surgery by a Physician, including medical and surgical benefits in connection with a mastectomy. In addition, in compliance with federal law, the Plan provides benefits for certain reconstructive surgery the same as other medical and surgical benefits. This covers reconstruction of the breast on which the mastectomy was performed, surgery on the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas. PHYSICIAN BENEFITS The Plan pays charges for Physician visits, including Physician office visits, subject to any required copayments. GENERAL MEDICAL BENEFITS The Plan pays for the following medical services: • Local ambulance service; • Blood and blood plasma; • Appliances; • X-rays; • Laboratory tests; • Anesthesia and its administration; • Use of radium and radioactive isotopes; and • Oxygen. Hospital Stays in Connection with Pregnancy The Plan complies with federal law that prohibits restricting benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96 hours following a cesarean section. Health care providers are not required to obtain authorization from the Plan for hospital stays within these guidelines. Federal law does not prohibit the physician, after consultation with the mother, from discharging the mother and/or her newborn earlier than 48 (or 96) hours. The Plan pays surgical benefits performed by non-PPO Providers based on the Allowable Charge. ORGAN TRANSPLANT BENEFITS The Plan pays benefits up to the amounts listed on the Summary of Benefits insert for the Program under which you are covered. Benefits are paid for both the organ donor and the organ recipient, provided both are eligible under this Plan. No benefits are payable for any expenses incurred for Experimental or Investigative procedures. The following organ procurement expenses will be paid when the transplant is performed in an in-network facility: • Hospital expenses incurred by a donor(s) as related to the transplant; • Testing to identify suitable donor(s) • The expense of life support of a donor pending the removal of a usable organ; and • Transportation of organ(s) or a donor on a life support system. You must call the Plan’s UR provider for preauthorization before receiving any transplant services. If you do not call for preauthorization, b...
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Surgical Benefits. (a) Doctor’s xxxx will be paid for surgical operations according to a standard “ Schedule of Operations” as set forth in the insurance certi­ ficate; maximum payment $350.00.
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Related to Surgical Benefits

  • 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.

  • 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.

  • 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.

  • Educational Benefits a. A full-time employee may enroll for credit at the University for a maximum of two courses, or six credit hours, whichever is greater, in any one academic term with exemption from the payment of tuition and fees.

  • General Benefits During the Term of Employment, the Executive shall be entitled to participate in such employee pension and welfare benefit plans and programs of the Company as are made available to the Company's senior-level executives or to its employees generally, as such plans or programs may be in effect from time to time, including, without limitation, health, medical, dental, long-term disability, travel accident and life insurance plans.

  • Public Benefits This Agreement provides assurances that the Public Benefits identified below will be achieved and developed in accordance with the Applicable Rules and Project Approvals and with the terms of this Agreement and subject to the City’s Reserved Powers. The Project will provide Public Benefits to the City, including without limitation:

  • Layoff Benefits All rights to which a certificated employee was entitled at the time of his/her layoff including unused accumulated sick leave and credits toward leave eligibility will be restored to the certificated employee upon his/her return to active employment, and the certificated employee will be placed upon the proper step of the salary schedule for the certificated employee's current position according to the certificated employee's experience and education.

  • Sick Benefits 15.01 Eligible employees will receive Short Term Disability Benefits in accordance with the terms and conditions outlined in the STD Plan Text, a copy of which has been supplied to the Union. The STD plan forms part of this Collective Agreement.

  • Education Benefits Notwithstanding the provisions of Article 5, academic staff members who qualify for benefits in accordance with Article 23.5.2.1 may take a credit, or non-credit language class offered by the University provided it does not interfere with performance of duties as determined by the Xxxx. The member and the Xxxx may discuss ways in which duties may be reassigned to make it possible for the member to take the class. Upon successful completion, reimbursement of tuition will be provided for one class per semester.

  • Medical and Dental Benefits If Executive’s employment is subject to a Termination, then to the extent that Executive or any of Executive’s dependents may be covered under the terms of any medical or dental plans of the Company (or an Affiliate) for active employees immediately prior to the Termination Date, then, provided Executive is eligible for and elects coverage under the health care continuation rules of COBRA, the Company shall provide Executive and those dependents with coverage equivalent to the coverage in effect immediately prior to the Termination. For a period of twelve (12) months (18 months for a Termination during a Covered Period), Executive shall be required to pay the same amount as Executive would pay if Executive continued in employment with the Company during such period and thereafter Executive shall be responsible for the full cost of such continued coverage; provided, however, that such coverage shall be provided only to the extent that it does not result in any additional tax or other penalty being imposed on the Company (or an Affiliate) or violate any nondiscrimination requirements then applicable with respect to the applicable plans. The coverages under this Section 4(e) may be procured directly by the Company (or an Affiliate, if appropriate) apart from, and outside of the terms of the respective plans, provided that Executive and Executive’s dependents comply with all of the terms of the substitute medical or dental plans, and provided, further, that the cost to the Company and its Affiliates shall not exceed the cost for continued COBRA coverage under the Company’s (or an Affiliate’s) plans, as set forth in the immediately preceding sentence. In the event Executive or any of Executive’s dependents is or becomes eligible for coverage under the terms of any other medical and/or dental plan of a subsequent employer with plan benefits that are comparable to Company (or Affiliate) plan benefits, the Company’s and its Affiliates’ obligations under this Section 4(e) shall cease with respect to the eligible Executive and/or dependent. Executive and Executive’s dependents must notify the Company of any subsequent employment and provide information regarding medical and/or dental coverage available.

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