Hospital Outpatient Sample Clauses

Hospital Outpatient. Lab, x-ray, medical equipment, surgical services, and substance abuse programs.
Sample 1
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Hospital Outpatient. Projected PMPM and Actual PMPM shall include claims costs for hospital outpatient facilities only for those categories of services subject to CareAdvantage review activities, i.e., ambulatory surgery, home health care, home infusion, and observation room. Hospital outpatient claims costs shall exclude claims costs incurred for mental health, substance abuse and ancillary services not provided in conjunction with those categories of services subject to CareAdvantage review activities, maternity-related services and ITS claims, as well as professional fees. Any other inclusions or exclusions will be prospectively agreed upon by the parties.
Sample 1
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.
Sample 1
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Outpatient Rehabilitation (Occupational Therapy, Physical Therapy, Speech Language Pathology)  Covered.  MCO.  Covers Covers physical therapy, occupational Part B. Outpatient evaluation and treatment for occupational, speech language pathology, and physical therapy. physical, therapy, speech Certain conditions and limitations apply. occupational, and pathology, and speech/language cognitive Any applicable cost sharing is covered by therapy. For rehabilitation the Medicaid benefit. Members have $0 FamilyCare B and therapy. cost sharing liability. C beneficiaries, limited to 60 days Covered for per therapy per services calendar year rendered beyond (except for MLTSS Medicare Part B members - refer to benefit limits. Appendix B.9.0).  (N.J.A.C. § See also
Sample 1
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment for medically necessary treatment provided by a doctor. Members also pay a copayment for foot exams related to diabetic peripheral neuropathy rendered in a hospital outpatient setting. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Prescription Drugs (including Medicare Part B and Part D)  Covered.  MCO and FFS Covered for services Part B: All Part B prescription drugs. (coverage differs rendered beyond Part D: Medicare Part D Prescription Drug for each).  Categorically Medicare Part B and Part D coverage is a required benefit for all SNPs. See 42 CFR 422.100(f)(3). Needy.  MCO coverage benefit limits. Includes Any applicable cost sharing is covered by excludes ABD prescription the Medicaid benefit. Members have $0 population and all drugs (legend cost sharing liability. other dual eligible and non-legend beneficiaries.  (N.J.A.C. covered by the Medicaid 10:49-5.2(a)18)  FFS covers program including legend and non- physician legend drugs for administered the ABD drugs); population and all prescription other dual eligible vitamins and beneficiaries.  (N.J.A.C. mineral products (except prenatal 10:49-5.2(b)15)  (N.J.A.C. § vitamins and fluoride) 10:74-3.4(a)2)  For the including, but not limited to, Medically Needy, therapeutic only available to vitamins, such as pregnant women high potency A, and needy D, E, Iron, Zinc, children (Groups A and minerals, and B) or aged, including blind, and disabled potassium, niacin beneficiaries and related residing in products. All Medicaid blood clotting participating factors shall be nursing facilities included in the (not available to list of blood any other ABD clotting factors. group).  (N.J.A.C. The contractor shall continue to 10:49-5.3(a)6) cover physician administered drugs for all enrollees in accordance with the list of applicable codes provided by DMAHS. Includes drugs which may be excluded from Medicare Part D coverage under section 1927(d)(2) referred to in the Medicare Modernization Act 2003. $0 cost-share for beneficiaries. Physician Services - Primary and Specialty Care  Covered. Covered for services rendered beyond Medicare Part B benefit limits. Part B. Covers medically necessary services and certain preventive services in outpatient settings. Physician services covered by Part B in some inpatient settings. Any applicable cost sharing is covered by the Medicaid benefit. Member...
Sample 1
Hospital Outpatient. The member pays a copayment for digital rectal exams in a hospital outpatient setting. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.
Sample 1
Hospital Outpatient. Treatment by a Physician or surgeon in the outpatient department of a hospital will be considered up to the Allowable Expense for such treatment.
Sample 1
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Hospital Outpatient. Outpatient hospital services at a network hospital will be subject to an $8.00 copayment. Effective June 1, 2005, the copayment will be $15.00. Mammographies and Cervical Cytology Screening. Coverage for cervical cytology screening once each health insurance contract year will be provided subject to the doctor's office limit and either an $8.00 copayment or deductible and coinsurance. Services for the examination of the Pap smear on a different date or at a different location than the office visit will result in a separate $8.00 copayment or deductible and coinsurance. Effective June 1, 2005, the copayment will be $10.00. Coverage will be provided for mammographies according to the guidelines outlined below subject to the doctor's office visit limit and an $8.00 copayment or deductible and coinsurance. Effective June 1, 2005, the copayment will be $10.00.
Sample 1
Hospital Outpatient. Plan will pay Provider at the then current Indiana Medicaid rates and methodology or its successor, less applicable Copayments.
Sample 1

Related to Hospital Outpatient

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

  • Health Care Coverage The Company shall continue to provide Executive with medical, dental, vision and mental health care coverage at or equivalent to the level of coverage that the Executive had at the time of the termination of employment (including coverage for the Executive’s dependents to the extent such dependents were covered immediately prior to such termination of employment) for the remainder of the Term of Employment, provided, however that in the event such coverage may no longer be extended to Executive following termination of Executive’s employment either by the terms of the Company’s health care plans or under then applicable law, the Company shall instead reimburse Executive for the amount equivalent to the Company’s cost of substantially equivalent health care coverage to Executive under ERISA Section 601 and thereafter and Section 4980B of the Internal Revenue Code (i.e., COBRA coverage) for a period not to exceed the lesser of (A) 18 months after the termination of Executive’s employment or (B) the remainder of the Term of Employment, and provided further that (1) any such health care coverage or reimbursement for health care coverage shall cease at such time that Executive becomes eligible for health care coverage through another employer and (2) any such reimbursement shall be made no later than the last day of the calendar year following the end of the calendar year with respect to which such coverage or reimbursement is provided. The Company shall have no further obligations to the Executive as a result of termination of employment described in this Section 8(a) except as set forth in Section 12.

  • Prescription Claims against the Issuer or any Guarantor for the payment of principal or Additional Amounts, if any, on the Notes will be prescribed ten years after the applicable due date for payment thereof. Claims against the Issuer or any Guarantor for the payment of interest on the Notes will be prescribed five years after the applicable due date for payment of interest.

  • Health Care Benefits (a) Each regular full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Business Travel, Lodging, etc Employer shall reimburse Executive for reasonable travel, lodging, meal and other reasonable expenses incurred by him/her in connection with his/her performance of services hereunder upon submission of evidence, satisfactory to Employer, of the incurrence and purpose of each such expense and otherwise in accordance with Employer’s business travel reimbursement policy applicable to its senior executives as in effect from time to time.

  • Health Care The Company will reimburse the Executive for the cost of maintaining continuing health coverage under COBRA for a period of no more than 12 months following the date of termination, less the amount the Executive is expected to pay as a regular employee premium for such coverage. Such reimbursements will cease if the Executive becomes eligible for similar coverage under another benefit plan.

  • Staffing Consultant will designate in writing to Authority its representative, and the manner in which it will provide staff support for the project, which must be approved by Authority. Consultant must notify Authority’s Contract Representative of any change in personnel assigned to perform work under this Contract, and the Authority’s Contract Representative has the right to reject the person or persons assigned to fill the position or positions. The Authority’s Contract Representative shall also have the right to require the removal of the Consultant’s previously assigned personnel, including Consultant’s representative, provided sufficient cause for such removal exists. The criteria for requesting removal of an individual will be based on, but not limited to, the following: technical incompetence, inability to meet the position’s qualifications, failure to perform, poor attendance, ethics violation, unsafe work habits, or damage to Authority or other property. Upon notice for removal, Consultant shall replace such personnel with personnel substantially equal in ability and qualifications for the positions and shall submit the proposed replacement personnel qualification and abilities to the Authority, in writing, for approval.

  • Health Care Compliance Neither the Company nor any Affiliate has, prior to the Effective Time and in any material respect, violated any of the health care continuation requirements of COBRA, the requirements of FMLA, the requirements of the Health Insurance Portability and Accountability Act of 1996, the requirements of the Women's Health and Cancer Rights Act of 1998, the requirements of the Newborns' and Mothers' Health Protection Act of 1996, or any amendment to each such act, or any similar provisions of state law applicable to its Employees.

  • Education Associate’s or Bachelor’s Degree, or technical institute degree/certificate in Computer Science, Information Systems or other related field. Or equivalent work experience.

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