Care Agency Sample Clauses

Care Agency. A Provider which renders care through a program for the treatment of a patient in the patient’s home, consisting of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the patient’s attending Physician. It must be licensed by the appropriate state agency.
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Care Agency. A Provider which renders care through a program for the treatment of a patient in the patient’s home, consisting of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the patient’s attending Physician. It must be licensed by the appropriate state agency. Hospice A Provider which provides care for terminally ill patients and their families, either directly or on a consulting basis with the patient’s Physician. It must be licensed by the appropriate state agency. Hospice Care Program A coordinated, interdisciplinary program designed to meet the special physical, psychological, spiritual and social needs of the terminally ill Member and his or her covered family members, by providing palliative and supportive medical, nursing and other services through at- home or Inpatient care. The Hospice must be licensed by the appropriate state agency and must be funded as a Hospice as defined by those laws. It must provide a program of treatment for at least two unrelated individuals who have been medically diagnosed as having no reasonable prospect of cure for their illnesses. Hospital An institution licensed by the appropriate state agency, which is primarily engaged in providing diagnostic and therapeutic facilities on an Inpatient basis for the surgical and medical diagnosis, treatment and care of injured and sick persons by or under the supervision of a staff of Physicians duly licensed to practice medicine, and which continuously provides 24-hour-a-day nursing services by registered graduate nurses physically present and on duty. “Hospital” does not mean other than incidentally: • An extended care facility; nursing home; place for rest; facility for care of the aged; • A custodial or domiciliary institution which has as its primary purpose the furnishing of food, shelter, training or non-medical personal services; or • An institution for exceptional or handicapped children. Identification Card The latest card given to You showing Your name, covered Dependents, Your ID numbers, the type of coverage You have the claim submission address, and phone numbers for Customer Service, Prior Authorizations and Pharmacy Help Line. Incapacitated Dependent A Dependent in which the subscriber or the subscriber’s spouse is the court-appointed legal guardian; and the dependent is mentally or physically incapable of earning a living as determined by the Ge...
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Care Agency. An agency which has been certified by the Colorado Department of Public Health and Enviroment as meeting the provisions of Title XVIII of the Federal “Social Security Act”, a amended, for licensed or certified home health agencies and which is engaged in arranging and providing: - nursing services; - home health aide services; and - other therapeutic and related services. • Hospice. A facility or service licensed by the Department of Public Health and Environment under a centrally administered program of palliative supportive, and interdisciplinary team services providing physical, psychosocial, spiritual, and bereavement care for terminally ill individuals and their families to be available 24 hours, 7 days a week. Hospice services shall be provided in the home, a Hospice facility, and/or other licensed health facility. • Home Health Services. Those items and services provided by Participating Providers as an alternative to hospitalization, and coordinated and pre-authorized by HMO.  Hospice Care. A program of care that is provided by a Hospital, Skilled Nursing Facility, Hospice, or a duly licensed Hospice Care agency, and is approved by HMO, and is focused on a palliative rather than curative treatment for Members who have agreed to admission and accepted into a Hospice, have a medical condition and a prognosis of less than 6 months to live. Hospice Care is not limited to medical intervention, but addresses: - physical; - psychosocial; and - spiritual needs of the patient. • Hospital(s). An institution rendering inpatient and outpatient services, accredited as a Hospital by the Joint Commission on Accreditation of Health Care Organizations, the Bureau of Hospitals of the American Osteopathic Association, or as otherwise determined by HMO as meeting reasonable standards. A Hospital may be a general, acute care, rehabilitation or specialty institution.
Sample 1

Related to Care Agency

  • Health Care Committee A Health Insurance Committee shall be established and maintained with at least three (3) representatives appointed by the Association and three (3) representatives appointed by the Superintendent. The purpose of the Committee shall be to make recommendations designed to optimize the quality of health care available to District employees and improve cost effectiveness of the health insurance program. Committee members shall review data, work with the District insurance consultant, collaborate on making recommendations for changes in plan design, review bids by insurance companies, and ultimately consider recommending plan changes to their respective constituencies. The Committee is not empowered to unilaterally make changes in health care benefits without ratification by the Association and approval by the Board. The creation of the Committee does not diminish or in any way reduce the Board’s and Association’s rights or responsibilities.

  • Professional Dress In as much as teachers are role models for students, each teacher shall maintain a neat, professional appearance appropriate for his/her specific teaching assignment.

  • 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.

  • 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.

  • Professional Organizations During the Term, Executive shall be reimbursed by the Company for the annual dues payable for membership in professional societies associated with subject matter related to the Company's interests. New memberships for which reimbursement will be sought shall be approved by the Company in advance.

  • Ambulance The deductible and coinsurance for services not subject to copays applies.

  • International Organization Any international organization or wholly owned agency or instrumentality thereof. This category includes any intergovernmental organization (including a supranational organization) (1) that is comprised primarily of non-U.S. governments; (2) that has in effect a headquarters agreement with Singapore; and (3) the income of which does not inure to the benefit of private persons.

  • Specialists Persons working within a juridical person who possess uncommon knowledge essential to the commercial presence’s production, research equipment, techniques or management. In assessing such knowledge, account will be taken not only of knowledge specific to the commercial presence, but also of whether the person has a high level of qualification referring to a type of work or trade requiring specific technical knowledge, including membership of an accredited profession.

  • Statewide HUB Program Statewide Procurement Division Note: In order for State agencies and institutions of higher education (universities) to be credited for utilizing this business as a HUB, they must award payment under the Certificate/VID Number identified above. Agencies, universities and prime contractors are encouraged to verify the company’s HUB certification prior to issuing a notice of award by accessing the Internet (xxxxx://xxxxx.xxx.xxxxx.xx.xx/tpasscmblsearch/index.jsp) or by contacting the HUB Program at 000-000-0000 or toll-free in Texas at 0-000-000-0000.

  • Professional Dues The school district will pay the annual dues for the Superintendent’s membership in the American Association of School Administrators, Association for Supervision and Curriculum Development, and Nebraska Council of School Administrators. The Superintendent’s membership in other professional organizations will be considered annually and may be approved at the discretion of the school board.

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