Basic Benefit Package Sample Clauses
The Basic Benefit Package clause defines the standard set of health care services and benefits that are provided to members under a health insurance plan. This package typically outlines which medical treatments, preventive services, and prescription drugs are covered, as well as any limitations or exclusions. By clearly specifying what is included, the clause ensures that both the insurer and the insured have a mutual understanding of coverage, reducing disputes and promoting transparency in the administration of health benefits.
Basic Benefit Package. After consideration of third party liability, including Medicare coverage pursuant to OAC rules 5160-58-01.1 and 5160-26-09.1, the MCOP shall ensure its members have timely access to all medically necessary medical, drug, emergency and post-stabilization, behavioral health, nursing facility, and home and community-based waiver services covered by Medicaid pursuant to OAC rules 5160-58-03, 5160-58-04, and 42 CFR 438.114 in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to members under FFS Medicaid in accordance with 42 CFR 438.210. This coverage shall be with limited exclusions, limitations, and clarifications (see OAC rule 5160-58-03 and specified in this appendix). The MCOP shall also ensure its members have access to any additional services specified in this Agreement. For information on Medicaid-covered services, the MCOP shall refer to the Ohio Department of Medicaid (ODM) website. Services covered by the MCOP benefit package include:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Services provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs);
d. Physician services whether furnished in the physician’s office, the member’s home, a hospital, or elsewhere;
e. Laboratory and x-ray services;
f. Screening, diagnosis, and treatment services to children under the age of 21 under the Healthchek, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. These services include all mandatory and optional medically necessary services (including treatment) and items listed in 42 U.S.C. 1396d(a) to correct or ameliorate defects and physical and mental illness and conditions. Such services and items, if approved through prior authorization, include those services and items listed at 42 U.S.C. 1396d(a), including services provided to members with a primary diagnosis of autism spectrum disorder, in excess of state Medicaid plan limits applicable to adults. An EPSDT screening is an examination and evaluation of the general physical and mental health, growth, development, and nutritional status of an individual under age 21. It includes the components set forth in 42 U.S.C. 1396d(r) and shall be provided by plans to children under the age of twenty-one;
g. Family planning services and supplies;
h. Home health and private duty nursing services in accordance with OAC Chapter 5160-12. State plan home health and private duty nursing service...
Basic Benefit Package. After consideration of third party liability, including Medicare coverage pursuant to OAC rules 5160-58-01.1 and 5160-26-09.1, the MCOP shall ensure its members have timely access to all medically necessary medical, drug, emergency and post-stabilization, behavioral health, nursing facility, and home and community-based waiver services covered by Medicaid pursuant to OAC rules 5160-58-03, 5160-58-04, and 42 CFR 438.114 in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to members under FFS Medicaid in accordance with 42 CFR 438.210. This coverage shall be with limited exclusions, limitations, and clarifications (see OAC rule 5160-58-03 and specified in this appendix). The MCOP shall also ensure its members have access to any additional services specified in this Agreement. For information on Medicaid-covered services, the MCOP shall refer to the Ohio Department of Medicaid (ODM) website.
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Services provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs);
Basic Benefit Package. The MCP shall ensure members have timely access to all services outlined in OAC rule 5160-26-03 in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to members under FFS Medicaid and in accordance with 42 CFR 438.210, with limited exclusions, limitations, and clarifications (specified in this appendix), including emergency and post-stabilization services pursuant to 42 CFR 438.114. For information on Medicaid-covered services, the MCP shall refer to the Ohio Department of Medicaid (ODM) website. Services covered by the MCP benefit package shall include:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Services provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs);
d. Physician services whether furnished in the physician’s office, the member’s home, a hospital, or elsewhere;
e. Laboratory and x-ray services;
Basic Benefit Package. After consideration of third party liability including Medicare coverage pursuant to OAC rules 5160‐58‐01.1 and 5160‐26‐09.1, a MyCare Ohio Plan (MCOP) must ensure its members have access to all medically‐necessary medical, drug, emergency and post‐stabilization, behavioral health, nursing facility and home and community‐based waiver services covered by Medicaid pursuant to OAC rules 5160‐58‐ 03 and 5160‐58‐04 and in 42 CFR 438.114. This coverage must be with limited exclusions, limitations and clarifications (see OAC rule 5160‐58‐03 and below in this Appendix). An MCOP must also ensure that its members have access to any additional services specified in this Agreement. For information on Medicaid‐covered services, MCOPs must refer to the Ohio Department of Medicaid (ODM) website. Services covered by the MCOP benefit package include, but are not limited to the following:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Rural health clinics (RHCs) and federally qualified health centers (FQHCs);
d. Physician services whether furnished in the physician’s office, the covered person’s home, a hospital, or elsewhere;
e. Laboratory and x‐ray services;
f. Screening, diagnosis, and treatment services to children under the age of 21 under the Healthchek, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. These services include all mandatory and optional medically necessary services (including treatment) and items listed in 42 U.S.C. 1396d(a) to correct or ameliorate defects and physical and mental illness and conditions. Such services and items, if approved through prior authorization, include those services and items listed at 42 U.S.C. 1396d(a) that are in excess of state Medicaid plan limits applicable to adults. An EPSDT screening is an examination and evaluation of the general physical and mental health, growth, development, and nutritional status of an individual under age 21. It includes the components set forth in 42 U.S.C. 1396d(r) and must be provided by plans to children under the age of twenty‐one;
g. Children’s Intensive Behavioral Health Service (CIBS) upon OAC rule implementation (date to be determined);
h. Family planning services and supplies;
i. Home health and private duty nursing services;
j. Podiatry;
k. Chiropractic services;
l. Physical therapy, occupational therapy, developmental therapy, and speech therapy;
Basic Benefit Package. By August 31 of each school year, the District shall inform the Association of its Basic 13 benefit package for the ensuing school year. The Basic Benefit Package shall include: Dental, Vision, Life and 14 Accidental Death and Dismemberment (AD&D), Long Term Disability (L&I), and Medical insurance, and 15 shall conform to applicable and current state law.
Basic Benefit Package. After consideration of third party liability including Medicare coverage pursuant to OAC rules 5160-58-01.1 and 5160-26-09.1, the MyCare Ohio Plan (MCOP) shall ensure its members have access to all medically-necessary medical, drug, emergency and post-stabilization, behavioral health, nursing facility and home and community-based waiver services covered by Medicaid pursuant to OAC rules 5160-58-03 and 5160-58-04 and in 42 CFR 438.114. This coverage shall be with limited exclusions, limitations and clarifications (see OAC rule 5160-58-03 and specified in this appendix). The MCOP shall also ensure its members have access to any additional services specified in this Agreement. For information on Medicaid-covered services, the MCOP shall refer to the Ohio Department of Medicaid (ODM) website. Services covered by the MCOP benefit package include:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Services provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs);
d. Physician services whether furnished in the physician’s office, the member’s home, a hospital, or elsewhere;
e. Laboratory and x-ray services;
f. Screening, diagnosis, and treatment services to children under the age of 21 under the Healthchek, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. These services include all mandatory and optional medically necessary services (including treatment) and items listed in 42 U.S.C. 1396d(a) to correct or ameliorate defects and physical and mental illness and conditions. Such services and items, if approved through prior authorization, include those services and items listed at 42 U.S.C. 1396d(a), including services provided to members with a primary diagnosis of autism spectrum disorder, in excess of state Medicaid plan limits applicable to adults. An EPSDT screening is an examination and evaluation of the general physical and mental health, growth, development, and nutritional status of an individual under age 21. It includes the components set forth in 42 U.S.C. 1396d(r) and shall be provided by plans to children under the age of twenty-one;
g. Family planning services and supplies;
h. Home health and private duty nursing services;
i. Podiatry;
j. Chiropractic services;
k. Physical therapy, occupational therapy, developmental therapy, and speech therapy;
l. Nurse-midwife, certified family nurse practitioner, and certified pediatric nurse practitioner services;
m. Free-standing birth center ...
Basic Benefit Package. The MCP shall ensure members have access to all services outlined in OAC rule 5160-26-03, with limited exclusions, limitations and clarifications (specified in this appendix), including emergency and post-stabilization services pursuant to 42 CFR 438.114. For information on Medicaid- covered services, the MCP shall refer to the Ohio Department of Medicaid (ODM) website. Services covered by the MCP benefit package shall include:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Services provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs);
Basic Benefit Package. The MCP shall ensure members have timely access to all services outlined in OAC rule 5160-26-03 in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to members under FFS Medicaid and in accordance with 42 CFR 438.210, with limited exclusions, limitations, and clarifications (specified in this appendix), including emergency and post-stabilization services pursuant to 42 CFR 438.114. For information on Medicaid-covered services, the MCP shall refer to the Ohio Department of Medicaid (ODM) website. Services covered by the MCP benefit package shall include:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Services provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs);