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 ?
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.
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.
In addition, it noted significant penalties for failing to submit a claim within one year for a covered service.
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.
Step 2: Determine whether the service is listed as a specified covered service.
It must include as participants all controlled taxpayers that benefit from one or more covered services subject to the SSA, and it must be structured so that each covered service or group of covered services confers a benefit on at least one participant.
At least one participant must benefit from each covered service (or reasonable aggregation of services), and
Covered Services under the Contract are set forth in this section.