El ambiente laboral y el clima laboral

Punto de vista Semiótico

2.2.2 Clima organizacional

2.2.2.2 El ambiente laboral y el clima laboral

T

his section shows how much we pay for Covered Services described in the Comprehensive Health Care Services section that follows. It also explains the Deductible you must pay before the Plan starts to pay for most Covered Services. Please note that services must be Medically Necessary in order to be covered under this program.

B

ENEFIT

P

ERIOD Calendar Year

The Copayment applies to charges which are billed as part of your Physician's office visit only and is limited to one Copayment per day per Provider. All other Physician office visit related services are subject to the Deductible and Coinsurance provisions of your coverage.

EXCEPTION: The office visit Copayment does not apply to the

following services:

S Surgical services;

S Physical Therapy and Occupational Therapy;

S Chemotherapy;

S Allergy testing and allergy injections;

S Preventive Care Services received from a BlueChoice, or BlueCard Provider.

S Covered childhood immunizations (for Subscribers under age 19);

S Prescription Drugs;

S Durable Medical Equipment.

The Copayment does not count toward the Deductible under this Certificate.

D

EDUCTIBLE

Out-of-Network Hospital Deductible

$300 per Inpatient Hospital Admission. This Deductible applies to all Covered Services Incurred during the Subscriber's admission to a Hospital which is not a BlueChoice or BlueCard Provider.

Benefit Period Deductible $1,000 per Benefit Period per Subscriber. The Benefit Period Deductible is in addition to the Out-of-Network Hospital Deductible or any other Deductibledescribed above.

This Deductible applies to Covered Services received from a BlueChoice or BlueCard Provider. If the Subscriber has Incurred expenses which were applied toward his or her Out-of-Network Provider Services Deductible during the Benefit Period, those expenses will also count toward satisfaction of his or her Deductible amount for BlueChoice or BlueCard Provider Service.

Covered Services Not Subject to Benefit Period Deductible

The Benefit Period Deductible applies to all Covered Services, except:

S Routine Nursery Care ($300 Out-of-Network Hospital Deductible

does apply).

S Annual routine gynecological/obstetrical examination and Pap smear.

S BlueChoice or BlueCard Physician services which are subject to the office visit Copayment.

S Preventive Care Services received from a BlueChoice or BlueCard Provider. Preventive Care Services received from an Out-of-Network Provider are subject to Deductible, except for : — Routine Diagnostic Medical Procedure/Routine EKG/Routine

X-ray/Routine Colorectal Cancer screening X-ray;

— Annual routine gynecological/obstetrical examination and Pap smear.

— Annual prostate cancer screening. — Routine Mammogram;

— Covered childhood immunizations (for Subscribers under age 19);

— Any other state or federally mandated Benefits which stipulate a Deductible may not be required.

S Outpatient Prescription Drugs.

S Ambulance Services. Out-of-Network Provider

Services Deductible

$1,000 per Benefit Period per Subscriber.

This Deductible applies whenever the Subscriber receives Covered Services from a Provider who is not a member of the BlueChoice or BlueCard Provider Network. If the Subscriber has Incurred expenses which were applied toward his or her BlueChoice or BlueCard Provider Services Deductible during the Benefit Period, those expenses will also count toward satisfaction of his or her Deductible amount for Out-of-Network Provider Services.

Deductible Credit If your Group changed carriers during your benefit period, expenses you Incurred and which were applied toward your Deductible during the last partial benefit period for services covered by the prior carrier will be applied to the Deductible of your initial Benefit Period under the Plan.

F

AMILY

D

EDUCTIBLE No family Subscriber will contribute more than the individual

Deductible amount.

If your coverage includes your Dependents, then:

S no more than three times the individual Deductible must be satisfied in each Benefit Period for all family members covered under your membership; and

S if two or more Subscribers under your membership incur expenses for Covered Services as a result of injuries received in the same accident, only one Deductible will be applied to the aggregate of such charges.

The Family Deductible provisions described above apply only to the Benefit Period Deductible and do not include any other Deductible applicable to your coverage.

O

UT-OF-

P

OCKET

L

IMIT

BlueChoice Provider Services When you have Incurred $3,300 including any Copayment and/or Deductible amounts) for Covered Services during a Benefit Period, the amount of Allowable Charges covered by the Plan on your behalf will increase to 100% during the remainder of the Benefit Period.

Out-of-Network Provider Services

When you have paid $3,800 (including any Copayment and/or Deductible amounts) for Covered Services during a Benefit Period, the amount of Allowable Charges covered by the Plan on your behalf will increase to 100% during the remainder of the Benefit Period.

The Out-of-Pocket Limit for in-network Provider Services and Out-of-Network Provider Services do cross apply.

The Out-of-Pocket Limits and Benefit percentage amount specified above do not apply to expenses Incurred for:

S Outpatient Prescription Drugs.

S Any penalty Incurred due to your failure to follow the Plan's guidelines for Preauthorization, as set forth in this Certificate.

S Charges in excess of the Allowable Charge.

BlueChoice Provider Services When you and your Dependents have paid $9,900 (including any Deductible and/or Copayment amounts) for Covered Services during a Benefit Period, the amount of Allowable Charges covered by the Plan on behalf of you and your Dependents will increase to 100% during the remainder of the Benefit Period.

Out-of-Network Provider Services

When you and your Dependents have paid $11,400 (including any Deductible and/or Copayment amounts) for Covered Services during a Benefit Period, the amount of Allowable Charges covered by the Plan on behalf of you and your Dependents will increase to 100% during the remainder of the Benefit Period.

M

AXIMUM Unlimited per lifetime per Subscriber

B

ENEFIT

P

ERCENTAGE The following chart shows the percentage of Allowable Charges

covered by your BlueChoice program through payments and/or contractual arrangements with Providers. These percentages apply only after your Deductible and/or Coinsurance has been satisfied.

COVERED SERVICES

(Subject to the Comprehensive Health Care

Services section which follows)

BENEFIT PERCENTAGE AMOUNT:

BlueChoice &

BlueCard

Provider Services

Out-of-Network

Provider Services

P

REVENTIVE

C

ARE

S

ERVICES

Covered Childhood Immunizations (limited to Subscribers under age 19)

100% 100%

Routine Diagnostic Services 100% 100% Routine EKG (Electrocardiography) 100% 100%

Routine X-rays 100% 100%

Routine Mammography 100% 100%

Annual prostate cancer screening 100% 100% Annual Routine Gynecological/

_{Applicable only to Covered Services which are subject to the office visit Copayment. For services which are not subject to}

COVERED SERVICES

(Subject to the Comprehensive Health Care

Services section which follows)

BENEFIT PERCENTAGE AMOUNT:

BlueChoice &

BlueCard

Provider Services

In document La comunicación interna y su incidencia en el clima organizacional del departamento de talento humano de la universidad Laica Vicente Rocafuerte de Guayaquil, período lectivo 2015 2016 (página 53-57)