Common use of Benefits and Exclusions Clause in Contracts

Benefits and Exclusions. Only medically necessary eligible services are covered. The State, after consultation with the JHCC, may carve-out procedures and services, including but not limited to, durable medical equipment, laboratory services, and prosthetics so that carved-out procedures and services may be provided by a vendor other than the participant’s health plan. After consultation with the JHCC, the Director of DAS may require participants to use centers of excellence for designated procedures or services. Additionally, upon the recommendation of the JHCC, the Director of DAS may place limits on certain benefits. 1. In-Patient Hospital Benefits: Health plans will offer at least the following hospital services: a. Unlimited duration of eligible medically necessary services except as provided herein. b. Semi-private room. c. Hospital ancillary services.

Benefits and Exclusions. Only medically necessary eligible services are covered. The State, after consultation with the JHCC, may carve-out procedures and services, including but not limited to, durable medical equipment, laboratory serviceslaboratory, and prosthetics so that carved-out procedures and services may be provided by a vendor other than the participant’s health plan. After consultation with the JHCC, the Director of DAS may require participants to use centers of excellence for designated procedures or services. Additionally, upon the recommendation of the JHCC, the Director of DAS may place limits on certain benefits. 1. In-Patient Hospital Benefits: Health plans will offer at least the following hospital services: a. Unlimited duration of eligible medically necessary services except as provided herein. b. Semi-private room. c. Hospital ancillary services.