Examples of Covered benefit in a sentence
If We have denied coverage on the basis that a service is not Medically Necessary (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment (including clinical trials and treatments for rare diseases), You or Your representative may appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these appeals.
No berm or ridge of any material shall be left along either shoulder of the roadbed unless directed by the COR.
If We have denied coverage on the basis that a service is not Medically Necessary (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment (including clinical trials and treatments for rare diseases); or is an out-of-network treatment, You or Your representative may Appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these Appeals.
If We have denied coverage on the basis that a service does not meet Our requirements for Medical Necessity (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment(including clinical trials and treatments for rare diseases), You or Your representative may appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these appeals.
PREVENTIVE MEDICATIONS: The term Preventive Medication means certain over-the-counter medications, which if prescribed by a licensed provider for a Member of the designated age/gender for the indicated circumstances or conditions shall be a Covered benefit under the Plan without Co-payment.