covered service

covered service

Covered health care service Managed care
1. A health care service to which a policy holder is entitled under the terms of a contract.
2. A service by a primary care provider in a managed care organization, which is not referred to a specialist.
3. Any medically necessary service, drugs or supplies–eg medical transportation services, which are covered under, and which plan members are entitled to receive under, a group benefits agreement. Cf Noncovered service.
References in periodicals archive ?
regulation, covered service providers had to provide plan committees-in their role as the responsible plan fiduciary-with disclosures about services, status and compensation.
Specifically, providers wanted to know how the Department of Labor would treat instances in which plan fiduciaries request information from covered service providers who believe the information is not specifically required under the fee disclosure rule and therefore don't want to provide it.
The second reporting is a disclosure of fees and expenses that must be made to each ERISA plan by each covered service provider.
If the test, procedure or surgery sounds unusual or you are unsure if it's a covered service, seek assistance from a Tricare service center near you.
Home visits are another problem; in many cases, they're also a covered service under Medicare.
If that patient is admitted to the SNF after a 3-day stay, Ullman acknowledged that the respiratory treatments would not be a covered service, because only the initial phases of treatment involving medical gases are considered to be a skilled level of care.
The PPO value plan is based on a table of allowances that shows the amount Delta Dental pays for each covered service, with the patient paying the remainder of the dentist's fee.
The attorneys wrote they are concerned that, if a covered service provider-for example, a broker-dealer, registered investment adviser (RIA) or recordkeeper-fails to make the 408(b)(2) disclosures to an Employee Retirement Income Security Act (ERISA)-covered plan or if the disclosure is incomplete, the service provider has engaged in a prohibited transaction with the plan; this is true, even if the failure is inadvertent.
In addition, it noted significant penalties for failing to submit a claim within one year for a covered service.
A description of all indirect compensation that the covered service provider, an affiliate, or subcontractor expects to receive in connection with the services