Pre-Service definition

Pre-Service claim means any claim for a benefit under the HPP with respect to which the terms of the HPP condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

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Pre-Service. An individual who has satisfactorily completed a California POST certified peace officer academy within three years of completion. This individual may possess only an academy graduation diploma or a diploma, and a basic POST certificate.

Pre-Service means an individual who is receiving the education and training to become a licensed teacher but is not yet licensed.

Examples of Pre-Service in a sentence

• AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim.

• An appeal of an Adverse Benefit Determination with respect to a Post-Service Claim may be submitted to AvMed’s Member Engagement Center, at the address listed in Appeal of a Pre-Service Claim, above.

• If a Claim is a Pre-Service or Urgent Care Claim, a Health Professional with knowledge of the Member’s Condition will be permitted to act as the Member’s authorized representative, and will be notified of all approvals on the Member’s behalf.

• A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination.

• An appeal of an Adverse Benefit Determination with respect to an Urgent Care Claim may be submitted to AvMed’s Member Engagement Center at the address listed under Appeal of a Pre-Service Claim, above.

• Expedited Appeals are not available for appeals regarding denied claims for benefit payment (Post-Service Claim) or for Pre-Service Claims that are not Urgent Care Claims.

• In the case of a failure by a Member or authorized representative to follow CareFirst BlueChoice procedures for filing a Pre-Service Claim, the Member or authorized representative shall be notified of the failure and the proper procedures to be followed in filing a claim for benefits.

• In the case of a Pre-Service Claim, CareFirst BlueChoice shall notify the Member of the benefit determination (whether adverse or not) within a reasonable period of time appropriate to the medical circumstances, but no later than 15 days after receipt of the claim.

• In the case of a Pre-Service Claim, the Member shall be notified of the benefit determination (whether adverse or not) within a reasonable period of time appropriate to the medical circumstances, but not later than 15 days after receipt of the claim.

• The Member can ask (either orally or in writing) for an Expedited Appeal of an Adverse Benefit Determination for a Pre-Service Claim that involves an Urgent Care Claim if the Member or his Physician believe that the health of the Member could be seriously harmed by waiting for a routine appeal decision.

More Definitions of Pre-Service

Pre-Service means those defined under clause 23 of this Regulation.

Pre-Service means any claim for benefits under the Contract which We must approve in advance, in whole or in part, in order for a benefit to be paid. Representative means someone who represents You for the purpose of the Appeal. The Representative may be Your personal Representative or a treating Provider. It may also be another party, such as a family member, as long as You or Your legal guardian authorize in writing, disclosure of personal information for the purposes of the Appeal. No authorization is required from the parent(s) or legal guardian of a Member who is an unmarried and dependent child and is less than 13 years old. For Expedited Appeals only, a health care professional with knowledge of Your medical condition is recognized as Your Representative. Even if You have previously designated a person as Your Representative for a previous matter, an authorization designating that person as Your Representative in a new matter will be required (but redesignation is not required for each Appeal level). If no authorization exists and is not received in the course of the Appeal, the determination and any personal information will be disclosed to You, Your personal Representative or treating Provider only.

Pre-Service means any school leaver, or person employed on temporary or contract basis, or person who may have previously received paid employment but is no longer being employed and under 25 years old.

Pre-Service means that receipt of the benefit, in whole or in part, is conditioned on approval in advance.