Emergency Room Services Copayment Sample Clauses

Emergency Room Services Copayment. A copayment will apply to non-emergency use of an emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Act. The copayment must be waived or returned if the member is found to have an emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency department. If a member contacts the Nurse Call line prior to seeking emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency services. Assuming a member has an available and accessible alternate non-emergency services provider and a determination has been made that the individual does not have an emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency services that:  The hospital may require payment of the copayment before the service can be provided;  The hospital provides the name and location of an alternate non-emer...
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Emergency Room Services Copayment. A copayment will apply to non-Emergency use of an Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active Labor Act. The copayment must be waived or returned if the member is found to have an Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical
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Related to Emergency Room Services Copayment

  • Emergency Room Services This plan covers services received in a hospital emergency room when needed to stabilize or initiate treatment in an emergency. If your condition needs immediate or urgent, but non-emergency care, contact your PCP or use an urgent care center. This plan covers bandages, crutches, canes, collars, and other supplies incidental to your treatment in the emergency room as part of our allowance for the emergency room services. Additional services provided in the emergency room such as radiology or physician consultations are covered separately from emergency room services and may require additional copayments. The amount you pay is based on the type of service being rendered. Follow-up care services, such as suture removal, fracture care or wound care, received at the emergency room will require an additional emergency room copayment. Follow- up care services can be obtained from your primary care provider or a specialist. See Dental Services in Section 3 for information regarding emergency dental care services.

  • Emergency Mode Operation Plan Contractor must establish a documented plan to enable continuation of critical business processes and protection of the security of electronic DHCS PHI or PI in the event of an emergency. Emergency means any circumstance or situation that causes normal computer operations to become unavailable for use in performing the work required under this Agreement for more than 24 hours.

  • Emergency Assistance Both Parties shall exercise due diligence to avoid or mitigate an Emergency to the extent practical in accordance with applicable requirements imposed by the Standards Authority or contained in the PJM Tariffs and NYISO Tariffs. In avoiding or mitigating an Emergency, both Parties shall strive to allow for commercial remedies, but if commercial remedies are not successful or practical, the Parties agree to be the suppliers of last resort to maintain reliability on the system. For each hour during which Emergency conditions exist in a Party’s Balancing Authority Area, that Party (while still ensuring operations within applicable Reliability Standards) shall determine what commercial remedies are available and make use of those that are practical and needed to avoid or mitigate the Emergency before any Emergency Energy is scheduled in that hour.

  • Emergency Childcare Employees may use vacation leave for childcare emergencies after the employee has exhausted all of their accrued compensatory time. Use of vacation leave and sick leave for emergency childcare is limited to a combined maximum of four (4) days per calendar year.

  • Routing for Operator Services and Directory Assistance Traffic For a Verizon Telecommunications Service dial tone line purchased by FTCS for resale pursuant to the Resale Attachment, upon request by FTCS, Verizon will establish an arrangement that will permit FTCS to route the FTCS Customer’s calls for operator and directory assistance services to a provider of operator and directory assistance services selected by FTCS. Verizon will provide this routing arrangement in accordance with, but only to the extent required by, Applicable Law. Verizon will provide this routing arrangement pursuant to an appropriate written request submitted by FTCS and a mutually agreed-upon schedule. This routing arrangement will be implemented at FTCS's expense, with charges determined on an individual case basis. In addition to charges for initially establishing the routing arrangement, FTCS will be responsible for ongoing monthly and/or usage charges for the routing arrangement. FTCS shall arrange, at its own expense, the trunking and other facilities required to transport traffic to FTCS’s selected provider of operator and directory assistance services.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Emergency Management The plan shall also address the assumption of operations of the program or facility by Department in the event of Contractor's bankruptcy or financial insolvency or if Contractor is unable to operate the facility.

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