Healthy Families InsuranceInsurance for healthy families
Guidance is provided by reviewing available CLI, which includes reviewing available CLI in peer-reviewed biomedical publications, the Regulatory State of the product or medication, evidence-based guidance from government agencies, and evidence-based guidance and position from selected healthcare agencies. The cover provisions are made on a case-by-case and case-by-case case-by-case approach and are governed by all provisions, restrictions, conditions as well as exclusion from the membership agreement, as well as those of medicinal need.
Concluding that a process, medicine, provision of care or delivery is necessary for medicinal purposes does not represent cover. A member's agreement shall specify which process, medication, service or delivery is included, prohibited, restricted or capped in dollars. Hospital criterions and health care regulations represent regulations for the determination of health care need criterions for certain methods, devices and care.
To be entitled to claim, all payments must be medicinally necessary and otherwise specified in the Member's Service Agreement as described in this "Important Notices" section. Irrespective of the case, the definitive performance provisions are always in the respective contractual languages. If there are conflicting provisions between health care regulations and the current contractual terminology, the contractual terminology shall apply.
Health care legislation should not suspend the legislation that governs the member's benefit, nor should it tell suppliers how to apply it. These guidelines are governed by current laws and regulations and by the requirement for advance notice. Where there is a mismatch between the entry into force of the Directive and the statutory provisions and regulative compliance, the statutory and regulative compliance shall apply.
Please consult your supplier's agent for information on the period of validity of the guidelines. There are no meanings in the Directives. Please consult your ISP for information on the definition of terminology used in the guidelines. These guidelines are not intended as providing health care counsel. There is no authorisation or warranty of cover. These guidelines do not represent approval or warranty for covering any particular process, medication, process, or delivery.
Affiliates and suppliers should reference the affiliation agreement to establish whether exemptions, restrictions and maximum dollars limits are applicable to a particular process, a particular substance, a particular product, a particular services or delivery. The member's contractual control controls cover determination. Material provided to you is a policy used by this Schedule to approve, change or refuse to provide assistance to any person with similar diseases or medical condition.
Special nursing services and treatments may differ according to your needs and the services provided under your agreement. Determining cover for a particular process, medication, service or delivery is not determined by the guidelines, but by the facts of the particular case, the membership agreement provisions and the demands of current law and regulation.
Contractual languages shall contain specified requirements, inclusive of preexisting requirements, restrictions, exclusion, performance limits, entitlement and other applicable requirements for cover. If there is a contradiction between the Member's Agreement (also known as the Service Agreement, Cover Documents or Proof of Cover) and the Guidelines, the Member's Agreement shall apply.
These guidelines do not supersede or modify the Membership Agreement. Determination of cover for a particular process, medication, service or delivery is governed by current laws and regulations and government regulations. Where there is a mismatch between the guidelines and the statutory provisions and the relevant regulations, the statutory and statutory provisions shall apply.
The California Heath and Safety Code is 1367. The 63rd prescribes healthcare curricula that include reconstruction surgeries. "Rekonstruktive Chirurgie" is an operation carried out to rectify or fix irregular bodily structure due to innate deficiencies, aberrations, traumas, infections, tumours or diseases in order to take one of the following measures: Reproductive surgeries do not mean "cosmetic surgery", i.e. surgeries that are carried out to change or remodel normally occurring bodily structure to enhance a person's look.
Applications for reconstruction may be rejected if the suggested procedures offer only a minimum enhancement of the applicant's look in accordance with the standards of medical professionals for reconstruction surgeries. The California Health and Safety Code is 1367. Section 6 involves the management of chest cancers in order to provide prosthetics or reconstruction surgical coverage to re-establish and reach symmetrical patients during masticectomy.
Cover for prostheses and reconstruction surgeries is covered by the co-payment or retention and co-insurance provisions that apply to breast augmentation and any other provisions that apply to other services. These Guidelines shall not be construed to restrict the services provided to Medicare and Medicaid members by laws and regulations.