Common use of Mental Health Care Provider Clause in Contracts

Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Non-Covered Services Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed to provide primary nursing and basic medical services. Out-of-Network Care Care received from an Out-of-Network Provider. Out-of-Network Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. Out-of-Pocket Maximum The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.

Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Non-Covered Services Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed to provide primary nursing and basic medical services. Out-of-Network Care Care received from an Out-of-Network Provider. Out-of-Network Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. Out-of-Pocket Maximum The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Non- Covered Services or fees in excess of the MAC. When the Out-of-of- Pocket Maximum is reached, the plan pays 100% 100 %of the MAC for Covered Services.

Mental Health Care Provider. An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Non-Covered Services Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed to provide primary nursing and basic medical services. Out-of-Network Care Care received from an Out-of-Network Provider. Out-of-Network Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- In-Network Provider contract with Alliant. Out-of-Pocket Maximum The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Non- Covered Services or fees in excess of the MAC. When the Out-of-of- Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.