Urgent Condition. This means a sudden sickness; injury; or condition; that: • Is severe enough to require prompt medical attention to avoid serious deterioration of the covered person’s health; • Includes a condition which would subject the covered person to severe pain that could not be adequately managed without urgent care or treatment; • Does not require the level of care provided in the emergency room of a hospital; and • Requires immediate outpatient medical care that cannot be postponed until the covered person’s physician becomes reasonably available.
Urgent Condition. The sudden, unexpected onset of a Medical Condition that is of sufficient severity to require medical treatment within twenty-four (24) hours of its onset. Usual, Customary and Reasonable (UCR): Expenses are considered Usual, Customary and Reasonable if the charges are consistent with those normally charged to others by the provider or organization for the same services or supplies; and the charges are within the general range of charges made by other providers in the same geographical area for the same services or supplies. Amounts charged by a Community Provider in excess of UCR rates are the responsibility of the Subscriber and/or Member. PREMIUM SCHEDULE Group Name Hanford Employee Welfare Trust (HEWT) - Exempt and Salaried Nonex Group Number (Primary/Secondary) 6966300/6227700 GROUP HEALTH OPTIONS INC. - Options benefit description Inside the Network: Managed Care Providers Outside the Network: Non Managed Care Providers Coinsurance 80/20% Coinsurance 70/30% Deductible $100 Deductible $200 Emergency Copay $75 Emergency Copay $125 Family Ded & OOP Max 2x Family Ded & OOP Max 2x Hospital Inpatient Copay None Hospital Inpatient Copay None Office Visit Copay None Office Visit Copay None Optical Rider $165/24 months Optical Rider CUSTOMIZED LANGU Out Of Pocket $1000 Out Of Pocket Threshold $2875 Outpatient Surgery Copay Same as OV Outpatient Surgery Copay Same as OON OV Prescription Drug Copay $15/$30 Prescription Drug Copay $20/$35 No PEC Wait Group Offering Dual Choice MONTHLY HEALTHCARE PREMIUM This Schedule reflects from: 01/01/2010 to 01/01/2011 Subscriber $470.91 Subscriber and 1 Dependent $861.76
Urgent Condition. An illness or injury that requires prompt medical attention but is not a life-threatening emergency medical condition. Value prescription drugs A group of medications determined by us that may be available at a reduced copayment or coinsurance and are noted on the drug guide. Walk-in clinic A health care facility that provides limited medical care on a scheduled and unscheduled basis. A walk-in clinic may be located in, near or within a: • Drug store • Pharmacy • Retail store • Supermarket The following are not considered a walk-in clinic: • Ambulatory surgical center • Emergency room • Hospital • Outpatient department of a hospital • Physician’s office • Urgent care facility Important Information about the Affordable Care Act (ACA) Non-discrimination Rule The Office of Civil Rights recently issued a Non-discrimination Rule in response to Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination because of race, color, national origin, sex, age or disability in health-related insurance or other health-related coverage. This applies to Aetna. Changes to health insurance plans are effective on the first day of the policy or plan year beginning on or after January 1, 2017. Some language changes may not be in the enclosed certificate of coverage or policy. This may be because the language is still under official review for approval. See the Important note below for how this affects your policy or plan. Important note: We will comply with the requirements of the Rule for all new and renewing policies or plans with an effective date on or after January 1, 2017. Below is a summary of some of the recent Non-discrimination Rule changes. An insurer covered by the Rule that provides or administers health-related insurance or other health- related coverage: • Shall not: o Cancel, limit or refuse to issue or renew a policy or plan o Deny or limit coverage of a claim o Apply additional cost sharing to a person because of race, color, national origin, sex, age, or disability. • Shall not: o Deny or limit coverage o Deny or limit coverage of a claim o Apply additional cost sharing to a transgender person, if it results in discrimination against that person. • Shall not exclude or limit health services related to gender transition. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health Care plans and their affiliates. Aetna...
Urgent Condition. A health condition, including a behavioral health condition, that is not an emergency but is severe or painful enough to cause a prudent layperson, possessing the average knowledge of medicine, to believe that their condition requires medical treatment evaluation or treatment within twenty-four (24) hours by the Enrollee’s PCP or PCP designee to prevent serious deterioration of the Enrollee’s condition or health.
Urgent Condition. An acute health condition with a sudden, unexpected onset, which is not Life threatening but which poses a danger to the health of the Member if not attended by a physician within 24 hours; e .g., serious lacerations, fractures, dislocations, marked increase in temperature, etc. Verbal preauthorization Prior approval obtained by calling HSA HEALTH INSURANCE COMPANY Customer Service in advance of treatment as required for some specific services and as documented by HSA HEALTH INSURANCE COMPANY. Waiting Period Waiting Period is a time that an employee is employed before they are eligible for the Employers’ health plan. Waiting periods may not be longer than 90 days from the time the employee is hired or otherwise eligible before they are eligible. Enrollment, Eligibility & Termination General Employees and their Dependents are eligible for Cover age as set forth herein. All Employees are required to enroll by completing and submitting a HSA HEALTH INSURANCE COMPANY Enrollment form or by completing an electronic Enrollment form through HSA HEALTH INSURANCE COMPANY’s online Enrollment portal. All information gathered and the information contained on the Enrollment form is incorporated into this contract. Any Enrollment or Coverage changes must be done in writing, by completing and submitting a HSA HEALTH INSURANCE COMPANY Enrollment form or by completing an electronic Enrollment form through HSA HEALTH INSURANCE COMPANY’s online Enrollment portal.
