Immunizations and Injections Clause Samples

Immunizations and Injections. This Plan covers immunizations and injections (including infusion therapy when administered by a health care professional in the office setting), professional services to inject the medications and the medications that are injected are covered. Preventive Care Services are covered under the “Preventive Care Services” heading as shown in this section, and in the “Schedule of Benefits and Copayments – SELECT 1” and "Schedule of Benefits and Copayments – SELECT 2 and SELECT 3" sections. Self-injectable drugs (other than insulin) and needles and syringes used with these self-injectable drugs are considered Specialty Drugs, which are subject to Prior Authorization and must be obtained through Health Net's contracted specialty pharmacy vendor. Your PCP or treating Physician will coordinate the authorization and upon approval, the specialty pharmacy vendor will arrange for the dispensing of the drugs, needles and syringes. The specialty pharmacy vendor will charge you for the appropriate Copayment or Coinsurance shown in "Schedule of Benefits and Copayments – SELECT 2 and SELECT 3.” Refer to Health Net’s Recommended Drug List on our website at ▇▇▇▇▇▇▇▇▇.▇▇▇ for the Specialty Drugs listing. You can also call the Customer Contact Center telephone number listed on your Health Net ID card. Immunizations for foreign travel/occupational purposes are not covered under SELECT 2 and SELECT 3 benefits. Durable Medical Equipment, which includes but is not limited to wheelchairs, crutches, bracing, supports, casts, nebulizers (including face masks and tubing) and Hospital beds, is covered and will be repaired or replaced when necessary. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to repair or replace an item. Health Net applies nationally recognized Durable Medical Equipment coverage guidelines as defined by the Medicare Durable Medical Equipment Regional Adminis- trative Contracts (DME MAC), HCPCS Level II and Medicare National Coverage Determinations (NCD) in assessing Medical Necessity for coverage. Some Durable Medical Equipment may have specific quantity limits or may not be covered as they are considered primarily for non-medical use. Nebulizers (including face masks and tubing) and Orthotics are not subject to such quantity limits.

Immunizations and Injections. Immunizations and injections, professional services to inject the medications and the medications that are injected are not covered. Immunizations and inoculations are not covered. Patient education programs on how to prevent illness or injury and how to maintain good health, including diabetes management programs and asthma management programs are not covered.

Immunizations and Injections. This plan covers immunizations and injections (including infusion therapy when administered by a health care professional in the office setting), professional services to inject the medications and the medications that are injected. Preventive Care Services are covered under the “Preventive Care Services” heading as shown in this section, and in the “Schedule of Benefits and Copayments – SELECT 1" and ”Schedule of Benefits and Copayments – SELECT 2 and SELECT 3" sections. Allergy serum is covered. In addition, injectable medications approved by the FDA to be administered by a health care professional in the office setting are covered.

Immunizations and Injections. This Plan covers immunizations and injections (including infusion therapy when administered by a health care professional in the office setting), professional services to inject the medications and the medications that are injected. This includes allergy serum. Preventive Care Services are covered under the “Preventive Care Services” heading as shown in this section, and in “Schedule of Benefits and Copayments,” Section 200. In addition, injectable medications approved by the FDA to be administered by a health care professional in the office setting are covered. Self-injectable Drugs (other than insulin), needles and syringes used with these self-injectable drugs are consid- ered Specialty Drugs, which are subject to Prior Authorization and must be obtained through Health Net's con- tracted specialty pharmacy vendor. Your PCP or treating Physician will coordinate the authorization and upon approval the specialty pharmacy vendor will arrange for the dispensing of the drugs, needles and syringes. The specialty pharmacy vendor may contact you directly to coordinate the delivery of your medications. Refer to Health Net’s Recommended Drug List on our website at ▇▇▇▇▇▇▇▇▇.▇▇▇ for the Specialty Drugs listing. You can also call the Customer Contact Center telephone number listed on your Health Net ID card. You will be charged appropriate Copayment as shown in "Schedule of Benefits and Copayments," Section 200.

Immunizations and Injections. This plan covers immunizations and injections (including infusion therapy when administered by a health care professional in the office setting), professional services to inject the medications and the medications that are injected. Preventive Care Services are covered under the “Preventive Care Services” heading as shown in this section, and in the “Schedule of Benefits and Copayments – SELECT 1" and ”Schedule of Benefits and Copayments – SELECT 2 and SELECT 3" sections. Allergy serum is covered. In addition, injectable medications approved by the FDA to be administered by a health care professional in the office setting are covered. Self-injectable drugs (other than insulin) and needles and syringes used with these self-injectable drugs are considered Specialty Drugs, which are subject to Prior Authorization and must be obtained through Health Net's contracted specialty pharmacy vendor. Your PCP or treating Physician will coordinate the authorization and upon approval, the specialty pharmacy vendor will arrange for the dispensing of the drugs, needles and syringes. The specialty pharmacy vendor will charge you for the appropriate Copayment or Coinsurance shown in "Schedule of Benefits and Copayments – SELECT 1." Refer to Health Net’s Recommended Drug List on our website at ▇▇▇▇▇▇▇▇▇.▇▇▇ for the Specialty Drugs listing. You can also call the Customer Contact Center telephone number listed on your Health Net ID card.

Immunizations and Injections. Benefits for immunizations include certain immunizations if an individual is determined to be at high risk. Keystone follows guidelines set by the Center for Disease Control in determining high-risk individuals. Immunizations for travel or for employment are not covered except as required by the Patient Protection and Affordable Care Act. Benefits include medical injections and other non-injectable drugs that must be administered by a health care provider because the patient needs to be monitored for side effects and compliance with dosage, there are complex shipping and/or storage requirements for the drug, and/or access to the drug may be limited. Medical Preauthorization is required. Members can view the list of medical injectable and other non-injectable drugs through the Preauthorization List posted on ▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇. Injectables that are "primarily self administered" are not covered under the Member’s medical Benefit under any circumstances, even if the Member is unable to self administer. In the event a Member is unable to self administer an injectable medication, only the charges for the administration of the injectable will be covered when administered and reported by an eligible Provider in an office, Hospital Outpatient, or home setting. Members can view the list of medications that Keystone considers to be primarily self administered by accessing the Self Administered Medications Policy on the Capital BlueCross website at ▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇.