The National Health Insurance Program Benefit Packages
|
|
|
- Nora Bennett
- 6 years ago
- Views:
Transcription
1 The National Health Insurance Program Benefit Packages
2 SOCIAL HEALTH INSURANCE in the PHILIPPINES 1969 Medicare Act (RA 6111) MEDICARE PROGRAM PMCC SSS GSIS 2
3 NHIP Republic Act 7875 as amended by RA 9241 National Health Insurance Program Philippine Health Insurance Corporation (PHILHEALTH) Abides by the pillars of: universal coverage, quality assurance and cost containment 3
4 Bayanihan Spirit : Working Together to achieve common goals PRINCIPLES OF NATIONAL HEALTH INSURANCE PROGRAM UNIVERSALITY SOCIAL SOLIDARITY CARE FOR THE INDIGENTS QUALITY ASSURANCE FOR HEALTH SERVICES LGU/ COMMUNITY PARTICIPATION 4
5 MEMBERS Employed Government Sector Private Sector Retirees and Pensioner (age 60 years old with 120 monthly contributions) Individually Paying Members Qualified Sponsored Members OFWs 5
6 COVERAGE also INCLUDES Member Spouse Parents who are 60 years old or above Children below 21 years old and those with mental and physical disabilities 6
7 Entitlement to Benefits at least 3 consecutive monthly contributions within the immediate 6 months prior to admission the 45-days allowance for room and board has not been consumed yet confinement in an accredited hospital of not less than 24 hours 7
8 MANDATED BENEFITS Inpatient Hospital Care room and board services of health care professionals diagnostic, laboratory, and other medical examination services use of surgical or medical equipment & facilities prescription drugs and biologicals subject to the limitations stated in Section 37 inpatient education packages 8
9 MANDATED BENEFITS Out Patient Care diagnostic, laboratory, and other medical examination services personal preventive services prescription drugs and biologicals subject to the limitations set in Section 37 limited to drugs in the Philippine National Drug Formulary and other PhilHealth Board approved drugs services of health care professionals 9
10 EXCLUSIONS BUT Non-prescription drugs and devices Alcohol abuse or dependency treatment Cosmetic surgery Optometric services Fourth and subsequent normal obstetrical deliveries Cost-ineffective procedures as be defined by the Corporation BUT may be included by the Board after actuarial studies 10
11 Exception to the 24 hr Confinement Emergency case as defined by PhilHealth Patient died Patient was transferred to another hospital 11
12 Availment Procedures 1. Member accomplishes PhilHealth Claim Form 1 2. Member submits the accomplished PhilHealth Claim Form 1 together with the Proof of Contribution (+ supporting documents) payment and a copy of his PhilHealth number card to the hospital Billing Section 3. The hospital will deduct PhilHealth benefits from hospital bill prior to discharge of the patient. The hospital will accomplish PhilHealth Claim Form 2 and submit it together with the PhilHealth Form 1 to any PhilHealth office for reimbursement. OTCCS 12
13 Claims Prescription Period Guidelines All claims for payment of services rendered shall be filed within 60 calendar days from the date of discharge of the patient. All claims returned for completion of requirements shall be re-filed within 60 calendar days from receipt of notice. All requests for payment adjustments must be made within 60 days from date of receipt of check payment or of the benefit payment notice. 13
14 Confinement in a Non-Accredited Hospital is possible IF : The case is Emergency, The Hospital has a current Department of Health (DOH) License, And transfer/referral to a PhilHealth accredited hospital is physically impossible. 14
15 BENEFIT SCHEDULE BENEFITS ITEMS CASE-TYPE A B C D LEVEL 1 HOSPITAL(Primary) ROOM AND BOARD (Not exceeding 45 days for each member P200/day P200/day N/A N/A & another 45 days to be shared by his dependents) DRUGS AND MEDICINES (per single period of confinement) 1,500 2,500 N/A N/A X-RAY, LABORATORY, ETC.(per single period of confinement) N/A N/A OPERATING ROOM FEE 385 N/A N/A N/A (RVU of 30 and below) LEVEL 2 HOSPITAL(Secondary) ROOM AND BOARD (Not exceeding 45 days for each member P300/day P300/day P300/day P660/day & another 45 days to be shared by his dependents) DRUGS AND MEDICINES (per single period of confinement) 1,700 4,000 8,000 19,725 X-RAY, LABORATORY, ETC.(per single period of confinement) 850 2,000 4,000 10,215 OPERATING ROOM FEE 670 2,160 2,160 6,480 (RVU of 30 and below) (RVU of 81 up to 200) (RVU of 201 up to 500) (RVU > 500) 1,140 (RVU of 31 up to 80) LEVELS 3 & 4 HOSPITALS (Tertiary) ROOM AND BOARD (Not exceeding 45 days for each member P400/day P400/day P400/day P1,035/day & another 45 days to be shared by his dependents) DRUGS AND MEDICINES (per single period of confinement) 3,000 9,000 16,000 35,655 X-RAY, LABORATORY, ETC.(per single period of confinement) 1,700 4,000 14,000 29,430 OPERATING ROOM FEE 1,060 3,490 3,490 10,470 (RVU of 30 and below) (RVU of 81 up to 200) (RVU of 201 up to 500) (RVU > 500) 1,350 (RVU of 31 up to 80) 15
16 BENEFIT SCHEDULE PROFESSIONAL FEES (per single period of confinement) General Practitioner CASE-TYPE A B C D P150/day not exceeding P600 P150/day not exceeding P900 P150/day not exceeding P900 P315/day not exceeding P2,430 Specialist P250/day not exceeding P1,000 P250/day not exceeding P1,500 P250/day not exceeding P2,500 P450/day not exceeding P4,050 Surgeon P40/RVU not exceeding P16,000 P40/RVU not exceeding P16,000 P40/RVU not exceeding P16,000 (P40/RVU) multiplied by 3 not exceeding P47,790 Anesthesiologist 30% of Surgeon's Fee not exceeding P5,000 30% of Surgeon's Fee not exceeding P5,000 30% of Surgeon's Fee not exceeding P5,000 30% of Surgeon's Fee not exceeding P14,355 16
17 CLAIM BENEFITS for CONFINEMENT ABROAD Entitlement to Benefits: - Member or his/her qualified dependents - Confinement/ Surgery or OPD Benefits o Benefit & Claims Filing calendar days fr.date of discharge - always payable to member - based on applicable benefit schedule, case type for a Tertiary level hospital 17
18 CONFINEMENT ABROAD cont d Documentary Requirements: 1. PH Form 1 2. Photocopy of MDR 3. Medical certificate/abstract (with English translation 4. SOA with itemized charges and/or ORs (proof of hospital bill and PF) 18
19 19
20 CURRENT PHILHEALTH BENEFIT PACKAGE DAY or AMBULATORY SURGERY PROCEDURES and SURGERIES General, Eye, ENT, Urological, Gynecologic, Orthopedic and other surgeries ALSO INCLUDES: DIALYSIS CARE for End Stage Renal Disease CHEMOTHERAPY and RADIOTHERAPY for Cancer cases MATERNITY CARE up to 3 rd Normal Deliveries (NSD) NEWBORN CARE PACKAGE (NCP) 20
21 MATERNITY CARE PACKAGE 21
22 MATERNITY CARE PACKAGE Normal Birth: Spontaneous onset of labor Low risk at the start of labor, throughout labor, and delivery Infant in vertex position completed weeks of pregnancy Payment Scheme: Reimbursement utilize a Case Payment Scheme Case Rate: Php 4,500 Limited to NSD of first three (3) births Providers: Non hospital based-facility RHUs/HCs Lying-in Clinics Hospitals basedfacility 22
23 MATERNITY CARE PACKAGE Payment for hospital based facility: 4,500 (per patient) P2, For the Health Professional P2, For the Health Facility (Room & Board, drugs & meds, diagnostics, OR OR fee) fee) 23
24 MATERNITY CARE PACKAGE Payment for Non-hospital based facility: Php 3,650 Prenatal delivery newborn care Php 850 postnatal care family planning services 24
25 MATERNITY CARE PACKAGE Eligibility: First prenatal visit of the member or dependent must not exceed the four (4) month age of gestation (AOG) of the current pregnancy IPP: All pregnancy related cases 9 monthly contributions within the immediate 12 months prior to delivery 25
26 MATERNITY CARE PACKAGE EXCLUSION: If first 2 pregnancies resulted in*: Cesarean section VBAC Breech delivery Preterm delivery Stillbirth * Counted as part of limitation of NSD package to the first 2 deliveries 26
27 MATERNITY CARE PACKAGE Claims Filing Claims for the first payment must be filed within 60 days from date of discharge For the second payment, claim must be filed within 90 days from date of discharge 27
28 NEWBORN CARE PACKAGE Php 1,000 benefit divided into: - Php 250 for HEP B vaccination - Php 500 for NEWBORN SCREENING - Php 250 for others NEWBORN PACKAGE For ALL QUALIFIED DEPENDENTS FIXED PAYMENTS for: -NEWBORN SCREENING - FIRST DOSE of HEPATITIS B BIRTH -BCG PROVIDERS: Hospital, RHUs/HCs,, Lying in REQUIREMENTS FOR ACCREDITATION: NSF Certified issued by DOH or NSRC 28
29 DOTS PACKAGE KONTRA TUBERCULOSIS Directly-observed Treatment Short Course 29
30 DOTS PACKAGE Care for TB patients Case payment: P4,000 Payment for MD, other health workers, referral centers No additional payment for: Additional services rendered Extension of treatment Coverage All members of the NHIP and all qualified dependents who satisfy the criteria of benefit eligibility and are not disqualified by the exclusion criteria For employed and IPP members: 3 months contribution paid within the immediate 6 months prior to enrollment at DOTS centers Plus: monthly premium paid during duration of DOTS course 30
31 DOTS PACKAGE CRITERIA FOR ELIGIBILITY New case A patient who never had treatment for TB ; or A patient who has taken anti-tb drugs for less than 1 month smear positive pulmonary TB smear negative pulmonary TB extrapulmonary TB TB disease in children EXCLUSION TB-DOTS Package will not cover the following types of TB cases: Failure cases (on previous treatment) Relapse Return after default (RAD) 31
32 DOTS PACKAGE 4,000 per patient 1 st st PAYMENT P2, After the Intensive Phase 2nd PAYMENT P1, After the Maintenance Phase 32
33 DOTS PACKAGE TREATMENT OUTCOME Claims for completed DOTS shall be paid regardless of treatment outcome Claims for patients who defaulted shall be denied CLAIMS FILING Claims with incomplete requirements shall be returned to the facility and must be complied within 60 days Non-compliance shall cause denial of claim 33
34 Benefit Administration Section 34
PhilHealth TB DOTS Out-patient Benefit Package
PhilHealth TB DOTS Out-patient Benefit Package WHO Consultation Eliminating the Catastrophic Economic Burden of TB: Universal Health Coverage and Social Protection Opportunities April 29, 2013 Sao Paulo,
CLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)
WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student
EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan
2018 EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan Summary Table of Benefits Select Medicare Supplement Plan PLAN REIMBURSEMENT METHOD DEDUCTIBLE - Individual Medicare
Successes and Failures in expanding and deepening coverage of health protection - the Philippine experience
Successes and Failures in expanding and deepening coverage of health protection - the Philippine experience Eduardo P. Banzon, MD, MSc Senior Health Specialist World Bank Health Protection CHARITY BEDS
OVERVIEW OF YOUR BENEFITS
OVERVIEW OF YOUR BENEFITS IMPORTANT PHONE NUMBERS Member Services Department (646) 473-9200 For answers to questions about your benefits or to be referred to another Benefit Fund department. Program for
1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS
1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS I HOSPITAL CARE This benefit is for the hospital s charge for the use of its facility only. Coverage for services rendered by doctors, labs,
SENIOR MED, LLC EMPLOYEE BENEFIT PLAN MEDICAL BENEFITS SCHEDULE LOW PLAN Effective April 1, 2014
LOW PLAN MAXIMUM BENEFIT AMOUNT: Aggregate Annual Limit NETWORK PROVIDERS NOTE: Benefits are only covered at Network Providers. No coverage is available at NON-NETWORK Providers, except where indicated
SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS
SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE
Kaiser Permanente Group Plan 301 Benefit and Payment Chart
301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.
Blue Shield High Deductible Plan
Blue Shield High Deductible Plan Benefit Booklet Stanford University Group Number: 170293, 976184 & 976185 Effective Date: January 1, 2014 An independent member of the Blue Shield Association Claims Administered
ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018
ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 All benefits are subject to the calendar year deductible, except those with in-network copayments,
FAMILY MEDICAL LEAVE (FMLA) OVERVIEW **********Keep this Overview for your own reference**********
FAMILY MEDICAL LEAVE (FMLA) OVERVIEW **********Keep this Overview for your own reference********** Office of Human Capital Division of Leaves Management 200 E. North Ave. Baltimore, MD 21202 Phone: 410-396-8885
Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION
Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION 2019 Summary of Important Changes for Contract Renewals for the Kaiser Permanente Group Plan (These changes are subject to regulatory
Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers
Health: Hospital Services provided by First Choice Preferred Provider Network Medical Services Radiology, Ultrasounds 20% after $500 individual or Laboratory Testing 20% after $500 individual or MRI and
FMLA LEAVE REQUEST FORM
FMLA LEAVE REQUEST FORM NAME: EMPLOYEE ID #.: TITLE: DEPARTMENT: _ LEAVE DATES REQUESTED: BEGINNING DATE: ENDING DATE: REASON FOR LEAVE REQUEST: (CHECK ONE AND ANSWER FOLLOW-UP QUESTIONS) (1) the birth
1. LAST NAME FIRST NAME MIDDLE INITIAL
THE CITY UNIVERSITY OF NEW YORK Queens College Family and Medical Leave Request Form Eligible employees are entitled to up to 12 weeks of unpaid job-protected leave for certain family and medical reasons.
Welcome Plan. Basic health insurance for temporary, new and returning Canadian residents
Welcome Plan Basic health insurance for temporary, new and returning Canadian residents Help your newest plan members feel at home Recognizing the skills and fresh perspectives that a diverse organization
FAMILY MEDICAL LEAVE (FMLA) OVERVIEW
FAMILY MEDICAL LEAVE (FMLA) OVERVIEW **********Keep this Overview for your own reference********** PLEASE READ THOROUGHLY (refer to FMLA process for detailed information) Office of Human Capital Division
Certification of Health Care Provider (Family and Medical Leave Act of 1993)
Certification of Health Care Provider (Family and Medical Leave Act of 1993) U.S. Department of Labor Employment Standards Administration Wage and Hour Division (When completed, this form goes to the employee,
Optima Health Provider Manual
Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating
HPHC Insurance Company, Inc. THE HPHC INSURANCE COMPANY DEDUCTIBLE TIERED COPAYMENT PPO PLAN MAINE
ID: MD0000003250 X Schedule of s HPHC Insurance Company, Inc. THE HPHC INSURANCE COMPANY DEDUCTIBLE TIERED COPAYMENT PPO PLAN MAINE This Schedule of s summarizes your benefits under the The HPHC Insurance
NY EPO OA 1-09 v Page 1
PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)
MEDICARE. 32 nd Annual Open Season Seminar
MEDICARE 32 nd Annual Open Season Seminar What is Medicare and who is eligible? Federal Health Insurance Program for aged and disabled o Over age 65 o Disabled workers o Patients with End Stage Renal Disease
SUMMACARE BRONZE 4000Q-15 SCHEDULE OF BENEFITS
SUMMACARE BRONZE 4000Q-15 SCHEDULE OF BENEFITS Enrollee Services Per Member/Per Family Calendar Year Deductible (In-network and out-of-network deductibles are separate. Deductible applies to all covered
SWEET HOME SCHOOL DISTRICT FAMILY AND MEDICAL LEAVE HANDBOOK
SWEET HOME SCHOOL DISTRICT FAMILY AND MEDICAL LEAVE HANDBOOK STEPS TO APPLY FOR OREGON FAMILY LEAVE &/OR FEDERAL MEDICAL LEAVE 1. Review handbook 2. Fill out a District Leave Request (attached) 3. Fill
Your leave will be counted against your 12 weeks per calendar year FMLA leave entitlement.
20-1923 (01-2018) Dear Employee, You may be eligible for leave under the Family and Medical Leave Act (FMLA) as described in the attachment, "Employee Rights and Responsibilities Under the Family and Medical
FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services
FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California
This plan is pending regulatory approval.
Bronze Full PPO 3000 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective October 1, 2015 THIS MATRIX IS INTENDED TO BE USED
2016 Medical Plan Comparison Chart
2016 Medical Plan Comparison Chart WellStar Health System is committed to helping you control healthcare costs while providing more choices and personal control over your healthcare coverage through the
MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015
MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS facilities and Aligned
PROVIDENCE Holy Cross Medical Center
PROVIDENCE Holy Cross Medical Center Department ofobstetrics & Gynecology Rules and Regulations I. NAME AND PURPOSE: The Name of this Department shall be the Department of Obstetrics and Gynecology of
Republic of the Philippines Department of Health Manila. HOSPITAL/OTHER HEALTH FACILITIES STATISTICAL REPORT For the Year
Republic of the Philippines Department of Health Manila HOSPITAL/OTHER HEALTH FACILITIES STATISTICAL REPORT For the Year Name of Health Facility: Complete Address: Region: Contact No. Fax No. E-mail Address
2017 Summary of Benefits
H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December
Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket
PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS
PLAN FEATURES Deductible (per calendar year) PHYSICIAN SERVICES Primary Care Physician Visits Specialist Office Visits Maternity OB Visits Allergy Treatment Allergy Testing PREVENTIVE CARE Routine Adult
State of New Jersey Aetna Medicare SM Plan (PPO)
PLAN FEATURES Deductible (per calendar year) Network Providers $0 Deductible Member Coinsurance N/A Applies to all expenses unless otherwise stated. Annual Maximum Out-of- $1,000 Pocket Amount (includes
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH PLANS INC.
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network Providers Annual Maximum Out-of-Pocket Amount $2,500 The maximum out-of-pocket limit applies to all
Summary of Benefits Advantra Freedom PEBTF
Advantra Freedom is a Medicare Advantage Private Fee-For-Service (PFFS) Plan. This Summary of Benefits tells you some features of our Plan. It doesn't list every service that we cover or list every limitation
SUMMARY OF BENEFITS 2009
HEALTH NET VIOLET OPTION 1, HEALTH NET VIOLET OPTION 2, HEALTH NET SAGE, AND HEALTH NET AQUA SUMMARY OF BENEFITS 2009 Southern Oregon Douglas, Jackson, and Josephine Counties, Oregon Benefits effective
Stanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits
Stanislaus County Medical EPO Option The following summary of benefits is a brief outline of the maximum amounts or special limits that may apply to benefits payable under the Plan. For a detailed description
Florida Medicaid. Outpatient Hospital Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
Combined Evidence of Coverage and Disclosure Form
Access+ HMO Combined Evidence of Coverage and Disclosure Form Santa Barbara City College Group Number: HSC214 Effective Date: October 1, 2012 An Independent Member of the Blue Shield Association Medical
Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived 30% after deductible
PLAN FEATURES NON- Deductible (per calendar year) $500 Individual $750 Individual $1,500 Family $2,250 Family All covered expenses, excluding prescription drugs, accumulate toward both the preferred and
Covered (blood, blood components, human blood products, and their administration) Covered (Some restrictions)
Washington Apple Health Medical Benefits Allergy Services (Antigen/Allergy Serum/Allergy Shots) Ambulance Services (Air Transportation) by FFS* Ambulance Services (Emergency Transportation) Ambulatory
Plan Overview. Health Net Platinum 90 HSP. Benefit description Member(s) responsibility 1,2
PureCare HSP is available through Covered CA in Kings, Madera, Sacramento, and Yolo counties, and parts of El Dorado, Fresno, Nevada, Placer, and Santa Clara counties. Plan Overview Health Net Platinum
Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived
PLAN FEATURES Deductible (per calendar year) $1,500 Individual $1,500 Individual $3,000 Family $3,000 Family All covered expenses, including prescription drugs, accumulate toward both the preferred and
Y0021_H4754_MRK1427_CMS File and Use PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract
Y0021_H4754_MRK1427_CMS File and Use 08262012 PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract Section I - Introduction to Summary of s Thank you for your interest in.
$25 copay per visit annual deductible applies. $30 copay per visit annual deductible applies
Minnesota Public Employees Insurance Program (PEIP) Advantage Health Plan 2018-2019 Benefits Schedule Benefit Provision Cost Level 1 You Pay Cost Level 2 You Pay Cost Level 3 You Pay Cost Level 4 You Pay
THIS INFORMATION IS NOT LEGAL ADVICE
Medicaid Medicaid is a federal/state program that gives certain groups of people a card that can be used to get free medical care, nursing home care, and prescription drugs at reduced prices. In general,
EVIDENCE OF COVERAGE AND PLAN DOCUMENT
EVIDENCE OF COVERAGE AND PLAN DOCUMENT A complete explanation of your plan HMO (Plan 4FR) Important benefit information please read Dear Health Net Member: This is your new Health Net Evidence of Coverage.
Illustrative Benefits, Value Added Services and Premiums are effective January 1, 2016 through December 31, 2016
PLAN FEATURES Combined In and Out of Network Deductible (Plan Level/includes Network Deductible) Network & Out-of-Network Providers $0 Member Coinsurance N/A Applies to all expenses unless otherwise stated.
CHAPTER 4 Section 3, pages 11 and 12 Section 3, pages 11 and 12. CHAPTER 6 Section 10, pages 1 and 2 Section 10, pages 1 and 2
CHANGE 10 6010.61-M NOVEMBER 15, 2017 REMOVE PAGE(S) INSERT PAGE(S) CHAPTER 1 Table of Contents, pages 1 and 2 Table of Contents, pages 1 and 2 Section 7, pages 1 and 2 Section 7, pages 1 and 2 Section
Payment Policy 19.0 (Service Codes): Updated to reflect process changes since the implementation of Claim- Check.
ANNUAL PAYMENT POLICY REVIEW PHP has completed its annual review of payment policies. The updated policies will be posted on ProvLink in January. Changes have been made to the following policies: Payment
The University of Rochester Policy: 358 Personnel Policy/Procedure Page 1 of 8 Created: 1/09
Personnel Policy/Procedure Page 1 of 8 Subject: Family Medical Leave Applies to: Faculty and staff who have been employed by the University for at least 12 months and who have worked a minimum of 1,250
2018 Summary of Benefits
2018 Summary of Benefits H5209-004_MDASB 9-13-17 Accepted 9/18/2018 DHS Approved 09/13/2017 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP)
GIC Employees/Retirees without Medicare
GIC Active Employees & Retirees without Medicare 7/1/18 GIC Employees/Retirees without Medicare HMO Summary of Benefits Chart This chart provides a summary of key services offered by your Health New England
Freedom Blue PPO SM Summary of Benefits
Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR
Benefits are effective January 01, 2017 through December 31, 2017
Benefits are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Network & Out-of- Annual Deductible $0 This is the amount
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II
HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible -
Medicaid Benefits at a Glance
Medicaid Benefits at a Glance Mountain Health Trust Benefits Children (0 up to 21 years) Ambulatory Surgical Center Services Any distinct entity that operates exclusively for the purpose of providing surgical
UNIVERSITY OF MICHIGAN BZK Effective Date: 01/01/2018
UNIVERSITY OF MICHIGAN 68712000 0070051870000-06BZK Effective Date: 01/01/2018 This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional
TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.
TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible
UNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE
November 1, 2016 UNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE NETWORK NON-NETWORK Lifetime Maximum Benefit Unlimited Unlimited Annual Deductible (Single/Family) $500/$1,000 $1,000/$2,000 Maximum
Cigna Health and Life Insurance Company. Plan Benefits. Unlimited. Unlimited. Not applicable. Not applicable. Not applicable
SUMMARY OF BENEFITS Client Name: Washington County Public Schools Benefit Option Name: Medicare Supplement Effective: July 1, 2018 through June 30, 2019 1 Benefit Description Lifetime Maximum Applies to
Get access to health care around the world. Blue Shield and UC help expats, their families, and travelers access health care abroad
Get access to health care around the world Blue Shield and UC help expats, their families, and travelers access health care abroad Effective January 1, 2016 A plan for your personal state of health Get
HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin
HealthPartners Freedom Plan 2011 Medical Summary of Benefits Wisconsin HealthPartners Wisconsin Freedom Plan I HealthPartners Wisconsin Freedom Plan II 420421 (10/10) H2462_SB WI_151 CMS Approved 10/5/10
Your Out-of-Pocket Type of Service
Calendar Year Deductible (CYD) 1 $3,000 single/ 3x family Out-of-Pocket Maximum - Deductibles and copays all accrue towards the out-of-pocket $6,200 single/ 2x family maximum. With respect to family plans,
Yes, for all plans, see or call for a list of network providers.
Important Questions (Massachusetts ) (New England ) (National ) What is the overall $0.00 Are there other s for specific? Is there an out of pocket limit on my expenses? What is not included in the out
Benefit Explanation And Limitations
Benefit Explanation And Limitations SFHP providers supply many medical benefits and services, some of which are itemized on the following pages. For specific information not covered in this table, please
Health plan Open Enrollment
2017-2018 Health plan Open Enrollment Offered through Day care council - local 205, DC 1707 Welfare Fund GOLDCARE MetroPlus.org/GoldCare 1.877.475.3795 2017-2018 HEALTH PLAN FOR DAY CARE WORKERS This is
WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus
Summary of benefits Health Net. seniority plus green. Benefits effective January 1, 2009 H0562 Medicare Advantage HMO
2009 Health Net Summary of benefits Los Angeles, Orange, Riverside and San Bernardino counties s effective January 1, 2009 H0562 Medicare Advantage HMO Material ID H0562-09-0041 CMS Approval 9/08 Section
HEALTH PLAN BENEFITS AND COVERAGE MATRIX
HEALTH PLAN BENEFITS AND COVERAGE MATRIX THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR
HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC.
HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible
ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.
ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services Alcohol, drug, and substance abuse treatment services are provided by the Department of Alcohol and Other Drug Abuse Services
A COMPLETE explanation of your plan
A COMPLETE explanation of your plan Legislative changes effective January 1, 2017 are not included in this document. An updated Evidence of Coverage will be available by January 31, 2017. For University
GREENWOOD LEFLORE HOSPITAL FINANCIAL ASSISTANCE POLICY
GREENWOOD LEFLORE HOSPITAL FINANCIAL ASSISTANCE POLICY Scope: This Greenwood Leflore Hospital ( Hospital ) Financial Assistance Policy ( FAP ) applies to all charges for emergency and medically necessary
Your Out-of-Pocket Type of Service
Calendar Year Deductible (CYD) 1 $0 single/ 3x family Out-of-Pocket Maximum - Deductibles, coinsurance and copays all accrue toward the outof-pocket maximum. With respect to family plans, an individual
Social Security Scheme on Health Care for Person Defined by the Provisions of the Labour Law. Date June, 16, 2016 Heng Sophannarith
Social Security Scheme on Health Care for Person Defined by the Provisions of the Labour Law Date June, 16, 2016 Heng Sophannarith ម ត ក I. Purpose II. Scope of Implementation III. Contribution IV. Benefits
All but Part A Deductible. Medicare Part A Deductible. Nothing. Inpatient Hospital All but Part A Medicare Part A Nothing.
Summary of Signature 65 Benefits Signature 65 is a Medicare-complimentary benefit program that fills in the coverage gaps and cost sharing of the traditional Medicare program (Medicare Part A and ). In
9.1.1 Medicaid Managed Care Enrollment Prior Authorization Emergency Ambulance Services
Section 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.1.1 Medicaid Managed Care Enrollment................................. 9-2 9.2 Reimbursement....................................................
Medicare Plus Blue SM Group PPO. Summary of Benefits. Michigan Public School Employees Retirement System
2018 Medicare Plus Blue SM Group Summary of Benefits January 1, 2018 December 31, 2018 Michigan Public School Employees Retirement System www.bcbsm.com/mpsers This information is a summary document and
SECTION II YOUR HEALTH BENEFITS
54 SECTION II YOUR HEALTH BENEFITS A. Participating Providers Member Choice Panel Providers B. Using Your Benefits Wisely 1199SEIU Care Review Ambulatory/Outpatient Surgery Pre-Certification Managed Care
NEVADA HEALTH CO-OP SOUTHERN STAR/ESTRELLA GOLD 100% 34996NV
NEVADA HEALTH CO-OP SOUTHERN STAR/ESTRELLA GOLD 100% 34996NV003 0002 Attachment A Benefit Schedule Lifetime Maximum: Unlimited. Benefits apply when you obtain or arrange for Covered through a Nevada Health
T M A V e r s i o n TABLE OF CONTENTS PART DEFINITIONS
(a) General. 1 (b) Specific definitions. 1 Abortion. 1 Absent treatment. 1 Abuse. 1 Abused dependent. 1 Accidental injury. 2 Active duty. 2 Active duty member. 2 Activities of daily living. 2 Acupuncture.
SCHEDULE OF MEDICAL BENEFITS
Annual Deductibles Annual Out-of-Pocket Maximums Inpatient Hospital Copayment (Excludes Deductible) $250 Individual $1,000 Individual $100 per day, not to exceed $500 Family $2,000 Family $600 per admission
FREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS 1. How do I avail of health care in the absence of my HMO ID? You may call Intellicare s 24/7 Customer Service Numbers for us to provide you your account number and endorse you
BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.
Michigan Catholic Conference Group Number: 71755 Package Code(s): 010 Section Code(s): 1000, 2000 PPO - PPO1, Hearing, Vision ( Exam only) Effective Date: 01/01/2018 Benefits-at-a-glance This is intended
HMO BLUE. VALUE HMO HMO Blue New England - $500 deductible (New England Network) PPO 90 Blue Care Elect Preferred 90 Copay (National Network)
Important Questions (Massachusetts ) (New England ) (National ) What is the overall $0.00 Are there other s for specific? Is there an out of pocket limit on my expenses? What is not included in the out
Vivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: Vivity
Vivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your : Vivity This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
HEALTH SAVINGS ACCOUNT (HSA)
HSA FEATURES Health Savings Account Amount $600 Employee $1,000 Family Amount contributed to the HSA by the employer. Funded on a quarterly basis. HSA amount reflected is on a per calendar year basis.
Summary of Benefits. January 1, 2018 December 31, Providence Medicare Dual Plus (HMO SNP)
Summary of Benefits January 1, 2018 December 31, 2018 Providence Medicare Dual Plus (HMO SNP) This plan is available in Clackamas, Multnomah and Washington counties in Oregon for members who are eligible
Telemedicine services $0 copay Not applicable Primary care provider (PCP) CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance
Calendar Year Deductible (CYD) 2 Plan includes an embedded individual deductible provision. An embedded deductible combines individual and family deductibles in $4,000 Single / $8,000 Family $12,000 Single
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network & Out-of- Annual Deductible This is the amount you have to pay out of pocket before the plan will pay
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services
MEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS.
ine 1-800-544-0088 www.care1st.com CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS MEDICARE 2009 COUNTIES: LOS ANGELES - ORANGE - SAN BERNARDINO - SAN DIEGO H5928_09_004_SNP_SB 10/2008 Section I Introduction
GOLD 80 HMO NETWORK 1 MIRROR
GOLD 80 HMO NETWORK 1 MIRROR Summary of Benefits Group An independent member of the Blue Shield Association (Intentionally left blank) Gold 80 HMO Network 1 Mirror Summary of Benefits The Summary of Benefits
Renee J. Rhem Director Customer Service ( ) 4/03 WELCOMELETTERV003
We would like to thank you for joining Keystone Health Plan East. Carrying a Keystone Identification Card (ID Card) entitles you to access a large network of providers, our friendly service, our value-added