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The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations.
Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage.
The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails.
Policy Effective Date and Defined Terms. The date of posting is not the effective date of the Policy.
The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification.
If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective.
For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net.
Policy Amendment without Notice. Health Net reserves the right to amend the Policies without notice to providers or Members. The Policies do not constitute medical advice.
Health Net does not provide or recommend treatment to Members. No Authorization or Guarantee of Coverage. The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions.
Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage.
Legal and Regulatory Mandates and Requirements The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements.
To improve function; or 2. To create a normal appearance, to the extent possible. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits.
Medicare and Medicaid Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members.
You are now leaving HealthNet. You may manually enter your ZIP code below: Or continue using the detected location: Your Current Location Is: Please select your county: Health Net of Arizona, Inc. HSA-compatible plans offer advantages of coverage with the tax-savings potential of a health savings account.
Employees can go directly to our broad PPO network of doctors and hospitals. Or they can see a doctor and use covered services outside the network.Association health plans for small business are being expanded due to a new Federal rule.
The biggest beneficiaries will be self-employed owners with no employees, as well as very small businesses with as few as one employee. These small business owners will soon be able to . Rocky Mountain Health Plans strives for a healthier Colorado by offering innovative health care plans to businesses of all sizes and individuals of all ages.
Affordable Care Act Requires Insurance Companies to Justify High Rate Hikes Health insurance premiums have risen rapidly, straining pocketbooks for American families and businesses.
Since , the health insurance premiums for family coverage have risen percent. Premium increases have forced families to spend more money for less coverage. Choosing a health care partner is one of the most important business decisions you can make. Kaiser Permanente can help you manage costs, invest in the health of your employees, and build a healthier future for your employees and your business.
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Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc.