Hospice Care If you have a terminal illness and you agree with your physician not to continue with a curative treatment program, this plan covers hospice care services received in your home, in a skilled nursing facility, or in an inpatient facility.
Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received: • as an inpatient; • as an outpatient; • in your home; • in a doctor’s office; or • from a pharmacy. Also coverage differs depending on whether: • the health care provider is a network provider or non-network provider; • deductibles (if any), copayments, or maximum benefit apply; • you have reached your plan year maximum out-of-pocket expense; • there are any exclusions from coverage that apply; or • our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.
XXXXXXXX ANTI-KICKBACK ACT (a) The Sub-Recipient hereby agrees that, unless exempt under Federal law, it will incorporate or cause to be incorporated into any contract for construction work, or modification thereof, the following clause:
Primary Care Clinic Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.
Urgent Care Services All Medically Necessary Covered Services received in Urgent Care Centers, Retail Clinics or your Primary Care Physician’s office after-hours to treat an Urgent Medical Condition will be covered by AvMed. Any request for reimbursement of payment made by a Member for services received must be filed within 90 days or as soon as reasonably possible but not later than one year unless the Member was legally incapacitated. If Urgent Medical Services and Care are required while outside the continental United States, Alaska or Hawaii, it is the Member’s responsibility to pay for such services at the time they are received. For information on filing a Claim for such services, see Part XIII. REVIEW PROCEDURES AND HOW TO APPEAL A CLAIM (BENEFIT) DENIAL.
Alcohol and Drug Testing Employee agrees to comply with and submit to any Company program or policy for testing for alcohol abuse or use of drugs and, in the absence of such a program or policy, to submit to such testing as may be required by Company and administered in accordance with applicable law and regulations.
Skilled Care in a Nursing Facility This plan covers skilled nursing services in a skilled nursing facility if: • the services are prescribed by a physician: • your condition needs skilled nursing services, skilled rehabilitation services or skilled nursing observation; • the services are provided by or supervised by licensed technical or professional medical personnel; and • the services are not custodial care, respite care, day care, or for the purpose of assisting with activities of daily living.
Health Care Operations Health Care Operations shall have the meaning set out in its definition at 45 C.F.R. § 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.
Occupational Health and Safety Act The Employer, the Union and the employees agree to be bound by the provisions of the Occupational Health and Safety Act, S.N.S. 1996, c.7.
OCCUPATIONAL HEALTH AND SAFETY 47 22.1 Statutory Compliance 47 22.2 Occupational Health and Safety Committee 47 22.3 Unsafe Work Conditions 49 22.4 Investigation of Accidents 49 22.5 Occupational First Aid Requirements and Courses 49 22.6 Occupational Health and Safety Courses 50 22.7 Injury Pay Provisions 50 22.8 Transportation of Accident Victims 50 22.9 Working Hazards 51 22.10 Video Display Terminals 51 22.11 Safety Equipment 51 22.12 Dangerous Goods, Special Wastes and Pesticides & Harmful Substances 51 22.13 Communicable Diseases 51 22.14 Workplace Violence 51 22.15 Pollution Control 52 22.16 Working Conditions 52 22.17 Asbestos 52 22.18 Employee Safety Travelling to and from Work 52 22.19 Strain Injury Prevention 52 ARTICLE 23 - TECHNOLOGICAL CHANGE 53 23.1 Definition 53 23.2 Notice 53 23.3 Commencing Negotiations 53 23.4 Failure to Reach Agreement 53 23.5 Training Benefits 53 23.6 Transfer Arrangements 54 23.7 Severance Arrangements 54 ARTICLE 24 - CONTRACTING OUT 54 24.1 Contracting Out 54 24.2 Additional Limitation on Contracting Out 54 ARTICLE 25 - HEALTH AND WELFARE 55 25.1 Basic Medical Insurance 55 25.2 Benefit Entitlement for Part-Time Regular Employees 55 25.3 Extended Health Care Plan 55 25.4 Dental Plan 56 25.5 Group Life 56 25.6 Accidental Death and Dismemberment 56 25.7 Business Travel Accident Policy 57 25.8 WorkSafeBC Claim 57 25.9 Employment Insurance 57 25.10 Medical Examination 57 25.11 Legislative Changes 57 25.12 Employee and Family Assistance Program 57 (v) 25.13 Health and Welfare Plans 57 25.14 Designation of Spouse 58 ARTICLE 26 - WORK CLOTHING 58 26.1 Protective Clothing 58 26.2 Union Label 58 26.3 Uniforms 58 26.4 Maintenance of Clothing 58 26.5 Lockers 58
