Mental Health Disorders Clause Samples

Mental Health Disorders. Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is Mental Health Care Provider An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Out-of-Network Care Out-of-Network Provider Out-of-Pocket Maximum The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services. Outpatient Outpatient Prescription Drug Formulary Physical Therapy Physician

Mental Health Disorders. Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical ornon-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders. New Hire A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. An individual duly licensed to provide primary nursing and basic medical services. Care received from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.

Mental Health Disorders. Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is Mental Health Care Provider An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Nurse Practitioner (NP) An individual duly licensed to provide primary nursing and basic medical services. Care received from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.

Mental Health Disorders. Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non- chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in New Hire A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Any item, service, supply or care not specifically listed as a Covered Service under this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. An individual duly licensed to provide primary nursing and basic medical services. Care received from an Out-of-Network Provider. A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have an In- Network Provider contract with Alliant. The maximum amount of a Member’s Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Premiums or charges for Non-Covered Services or fees in excess of the MAC. When the Out-of-Pocket Maximum is reached, the plan pays 100% of the MAC for Covered Services.

Mental Health Disorders. ‌ Mental Health Care Provider‌ Minimum Essential Coverage New Hire‌ Non-Covered Services‌ Nurse Practitioner (NP) Out-of-Network Care‌ Out-of-Network Provider‌ Out-of-Pocket Limit‌ Periodic Health Assessment‌ Physical Therapy‌ Physician‌ Physician Assistant (PA)‌ Physician Assistant Anesthetist (PAA)‌ Plan Administrator‌