Preventive Health Benefits Sample Clauses

Preventive Health Benefits. Preventive Care Services are those primary preventive medi- cal Services provided by a Physician for the early detection of disease when no symptoms are present and for those items specifically listed below. The specific benefits listed below for Preventive Care are not subject to the Calendar Year Deductible. No benefits are provided for Preventive Care Services pro- vided from Non-Preferred Providers. Note: Diagnostic audiometry examinations are covered under the Professional (Physician) Benefits.
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Preventive Health Benefits. Preventive Health Services are only covered when provided or arranged by the Member’s Primary Care Physician. Preventive Health Services include primary pre- ventive medical and laboratory services for early detection of disease as specifically listed below:
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Preventive Health Benefits. Each Insured is eligible to receive the following preventive services paid at 100% of the allowable charge when received from a Contracting Provider for preventive (i.e., not diagnostic or treatment) purposes. Preventive Health Services received from a Non-Contracting Provider will be subject to the cost-sharing requirements (including copayments, coinsurance and deductible), applicable hereunder, in a manner consistent with 42 U.S.C. 300gg-13 for:
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Preventive Health Benefits. Annual routine physical examination office visit: including physical examination office visit, routine eye/ear screening for members through age 18 and pediatric and adult immunizations and the immunization agent. Annual routine gynecological office visit: including the gynecological examination office visit, routine mammography, routine Papanicolaou (Pap)test or other FDA approved cervical cancer screening test, human papillomavirus (HPV) screening tests (One per calendar year) Routine laboratory services, including well baby laboratory services Well baby office visit: including well baby examination office visit, pediatric immunizations and the immunization agent, well baby vision and hearing screening No charge (Not subject to the Calendar-Year Deductible) No charge (Not subject to the Calendar-Year Deductible) No charge (Not subject to the Calendar-Year Deductible) No charge (Not subject to the Calendar-Year Deductible) Not covered 50%2 50%2 50%2 OUTPATIENT SERVICES Hospital Benefits (Facility Services) Outpatient surgery performed at an Ambulatory Surgery Center3 20% No charge12 (up to $350 per day maximum payment) Outpatient surgery in a hospital 20% No charge12 (up to $350 per day maximum payment) Outpatient Services for treatment of illness or injury and necessary supplies (Except as described under "Rehabilitation benefits") 20% 50%2 Outpatient X-ray, pathology and laboratory performed in a hospital3 20% 50%2, 12 (up to $350 per day maximum payment) Outpatient diagnostic testing performed in a hospital3 20% 50%2, 12 (up to $350 per day maximum payment) Bariatric Surgery (pre-authorization required; medically necessary surgery for weight loss, only for morbid obesity)4 20% No charge12 (up to $350 per day maximum payment) An Independent member of the Blue Shield Association HOSPITALIZATION SERVICES Hospital Benefits (Facility Services) Inpatient Physician Services 20% 50%2, 13 Inpatient Non-emergency Facility Services (Semi-private room and board, medically necessary services and supplies) 20% No charge12 (up to $600 per day maximum payment) Bariatric Surgery (pre-authorization required; medically necessary surgery for weight loss, only for morbid obesity)4 20% No charge12 (up to $600 per day maximum payment) Skilled Nursing Facility Benefits (Combined maximum of up to 100 preauthorized days per calendar year; semi-private accommodations) Services by a free-standing Skilled Nursing Facility 20% 20%6 Skilled Nursing Unit of a Hospital 20% No charge12...
Sample 1
Preventive Health Benefits. Preventive Health Services are only covered when provided or arranged by the Member’s Personal Physician. xxx.xxxxxxxxxxxx.xxx/xxxxxxxxxx or by calling Customer Service. In the event there is a new recommendation or guideline in any of the resources described in items 1) through 4) above, the new recommendation will be covered as a Preventive Health Service no later than 12 months following the issuance of the rec- ommendation.
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Preventive Health Benefits. Preventive Health Services include primary preventive medical screening and laboratory testing for early detection of disease as specifically listed below:
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Related to Preventive Health Benefits

  • Retiree Health Benefits 1. There is currently in effect a retiree health benefit program for retired members of LACERS under LAAC Division 4, Chapter 11. All covered employees who are members of LACERS, regardless of retirement tier, shall contribute to LACERS four percent (4%) of their pre-tax compensation earnable toward vested retiree health benefits as provided by this program. The retiree health benefit available under this program is a vested benefit for all covered employees who make this contribution, including employees enrolled in LACERS Tier 3.

  • Health Benefits The method for determining the Employer bi-weekly contributions to the cost of employee health insurance programs under the Federal Employees Health Benefits Program (FEHBP) will be as follows:

  • Extended Health Benefits The extended health benefits coverage for CUPE and Fire will be amended to include:

  • Employee Health and Safety A. When the University requires an employee to use or wear health or safety equipment, such equipment will be provided by the University.

  • Extended Health Benefit Reimbursement is provided for many types of services, such as registered nurse, physiotherapist, wheelchairs, braces, crutches, ambulance service, chiropractors, to name a few. Pre-authorization is required for the rental and/or purchase of all durable equipment and all Nursing Care/Home Care benefits. Certain dollar amounts or time period maximums apply. It is important to note that reimbursement under the extended health care benefit is made at 80% of covered eligible expenses up to $5,000; expenses over $5,000 and less than $10,000 are reimbursed at 90%, and expenses over $10,000 are reimbursed at 100% in any calendar year. Where no maximum eligible expense is noted, reasonable and customary rates will apply. Please consult your online employee benefit booklet for details. Services not Covered Under the Supplementary Health Insurance Program You and/or your dependents are not covered for medical expenses incurred as a result of any of the following:  Expenses private insurers are not permitted to cover by law  Services or supplies for which a charge is made only because you have insurance coverage  The portion of the expense for services or supplies that is payable by the government public health plan in your home province, whether or not you are actually covered under the government public health plan  Any portion of services or supplies which you are entitled to receive, or for which you are entitled to a benefit or reimbursement, by law or under a plan that is legislated, funded, or administered in whole or in part by a provincial / federal government plan, without regard to whether coverage would have otherwise been available under this plan  Services or supplies that do not represent reasonable treatment  Services or supplies associated with: o treatment performed only for cosmetic purposes o recreation or sports rather than with other daily living activities o the diagnosis or treatment of infertility o contraception, other than contraceptive drugs and products containing a contraceptive drug  Services or supplies associated with a covered service or supply, unless specifically listed as a covered service or supply or determined by Great-West Life to be a covered service or supply  Extra medical supplies that are spares or alternates  Services or supplies received out-of-province in Canada unless you are covered by the government health plan in your home province and Great-West Life would have paid benefits for the same services or supplies if they had been received in your home province  Expenses arising from war, insurrection, or voluntary participation in a riot  Chronic care  Podiatric treatments for which a portion of the cost is payable under the Ontario Health Insurance Plan (OHIP). Benefits for these services are payable only after the maximum annual OHIP benefit has been paid  Vision care services and supplies required by an employer as a condition of employment  Prescription sunglasses and safety glasses Group Travel Insurance The group travel plan covers a wide range of benefits which may be required as a result of an accident or unexpected illness incurred outside the province while travelling on business or vacation. The insurer will pay 100% of the reasonable and customary charges (subject to any benefit maximums) for expenses, such as hospital, physician, return home and other expenses as outlined in the employee booklet. Coverage under Group Travel Insurance is limited to a maximum of ninety (90) days per trip for travel within Canada. Coverage commences from the actual date of departure from your province of residence. Coverage under Group Travel Insurance is limited to thirty (30) days per trip for travel outside Canada. Coverage commences from the actual date of departure from Canada. A person with an existing medical condition must be stable for 3 months prior to travelling. Stable means there has been no period of hospitalization, no increase or modification in treatment or prescribed medication, or no symptom for which a reasonably prudent person would consult a physician. Stable dosage does not apply to diabetics. Additional coverage is available from Great-West Life on an optional pay all basis.

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Accident Prevention Health and Safety Committee The Employer and the Union agree that they mutually to maintain standards of safety and health in the Hospital in order to prevent accidents, injury, and illness. ected or Recognizing its responsibilities under the applicable legislation, the Hospital agrees to accept as a member of its Accident Prevention Health and Safety Committee, at least one (1) representative sel appointed by the Union from amongst Bargaining Unit employees. Such Committee shall identify potential dangers and means of improving health and safety programs, and recommend actions to be taken to improve conditions related to safety and health. The Hospital agrees to co-operate reasonably in providing necessary information to enable the Committee its functions. Meetings shall be held every second month or more frequently at the call of the Chair if required. The Committee shall maintain minutes of meetings and make the Same available for review. Any representative appointed or accordancewith hereof shall serve for a term of one (1) calendar year from the date of appointment which may be renewed for further of one (1) year. Time off for such to attend meetings of the Accident Prevention Health and Safety Committee in accordance with the foregoing shall be granted, and any attending such meetings during their regularly scheduled hours of work shall not lose regular as a result of such The Union agrees to endeavour to obtain the membership in the observation of all safety rules and practices. Safety Shoes The Hospital will provide sixty dollars ($60.00) annually effective April and eighty dollars ($80.00) effective April to each employee who is required by the Hospital, as delineated below, to wear safety footwear during the of his duties. The Hospital will require employees the following functions to wear appropriate Engineering Services; Grounds; Transport; (only where frequently working in storage areas). (as determined by the Hospital) heavy carts on a regular basis, e.g., linen carts, food wagons. ARTICLE BULLETIN BOARDS The Employer shall provide bulletin that all employees will have access to them have the right to post notices of meetings and such other notices as may be of interest to the membership. The wage increase listed on a retroactive to contact,in writing (with a copy to the Union) at their last-known entitle who have left its employ, to advise them of their any retroactive wage adjustment. Any employees who have employees shall have notice from the Hospital in which to claim from the Hospital any adjustment to their remuneration entitlement. The retroactive payments shall be made by separate cheques to the employees so entitled within sixty (60) days from the date of ratification. All other adjustments shall be effective as set out specifically in this Collective Agreement.

  • Continuation of Health Benefits An eligible employee who is on an approved FML Leave shall be entitled to continue participation in health plan coverage (medical, dental, and optical) as follows:

  • Workplace Safety Insurance Benefits (WSIB) Top Up Benefits If the employee is in a class of employees that, on August 31, 2012, was entitled to use unused sick leave credits for the purpose of topping up benefits received under the Workplace Safety and Insurance Act, 1997;

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