Agenda - Council - 11/22/1983 - Laserfiche WebLink

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TH~ ~J NOT A COIfPLKT~ DKHCRIP'ITON' OF ~. THE MA~'I'F~ CONTRACT WILL GOVERN .THE ADMINISTRATION OF ALL CLA.1M8 COMPARISON OF BENEFITS IN GROUP HEALTH, PHYSICLANS HEALTH AND MEDCENTERS HEALTH PLANS (Effective January 1, 1984) GROUP HEALTH PHYSICIANS HEALTH MEDCENTERS HEALTH PLAN PLAN PLAN Reconstructive Surgery (Continued) Choice of doctor I). Choice of hospitals I. I I I / I I I Registered nursing service in home Dental Care Definition of Dependents ness, or other diseases-of the involved part or when such service is performed on a covered dependent child because of congenital disease or anomaly which has resulted in a func- tional defect as deter- mined by the attending GHP physician. · C. Free choice of GHP physicians. QoRefer to listing f participating hospitals. Ee Covered under supple- mental services if prescribed by GHP physician. G}Not covered except for (1) repair of sound teeth following accidental injury to natural teeth subject to enrollee co- payment for prosthetic devices (2) hospitaliza- tion necessary due to pre-existing medical eon- ditions (3) preventive dentistry services for dependent children up to age 19, which are covered in full if provided by GHP dentist. Spouse; unmarried dependent children under age 19 or age 9.3 if full-time student; unmarried dependent children of any age who become physically handicapped or mentally disabled before reaching age 19, or if a stud,ut, before age 23, if Ce De occurred after the member~ effective date of coverage{ you pay 25~ of the cost, up to a maximum copayment of $1,500 per hospital confinement, when the con- dition requiring surgery existed prior to the member~ effective date of coverage (copayment does not apply to physician office ser- vices). Service must be provided by PHP physician or plan-approved referral.: Free choice of participating physicians. Free ehoiee of partici- pating hospitals and others on approved referral & emergency. Refer to listing of participating hospitals. Covered under supple- mental services if pre- scribed by PHP physician and approved by plan in advance. Not covered except for (1) repair of sound teeth following accidental injury to natural teeth, which is covered 80~ under supplemental services (g) medically necessary hospitalization for dental treatment. Spouse; unmarried dependent ehildren age 19 or age 23 if full-time student; unmarried dependent children of any age who become physically handicapped or mentally disabled before reaching age 19, or if a student, before age 23, if disability occurred from injury, illness, or other diseases of the involved part{ you pay 20~ of the cost when the condition requiring such surgery existed prior to the member~ effective date of coverage. Service must be ordered by a MCHP physician. C. Free choice of MCHP physicians. De Limited to participating MCHP hospitals and others on referral or emergency. Refer to listing of participating hospitals. Es Covered under supple- mental services if prescribed by MCHP physician. (~vPreventive dental set- tees for dependent children under age 19 will be covered in full if provided by a MCHP dentist. No other cov- erage, except for repair of sound teeth following accidental injury to natural teeth which is covered 80~ under supplemental coverage. Spouse; unmarried depen- dent children under age 19 or age 25 if full- time student; unmarried dependent children of any age who become physically handicapped or mentally disabled before reaching age 19, or if a student before age 25, if disability occurred while covered under the contract; divorced