Hearing Examinations and Hearing Aids. Hearing examinations to determine hearing loss Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment. • Hearing aids, including hearing aid examinations Not covered. Home Health Services Covered in full. No visit limit. Hospice Services Covered in full. Inpatient respite care is covered for a maximum of five (5) consecutive days per occurrence. Infertility Services (including sterility) • General diagnostic services Covered subject to the lesser of GHC's charge or the applicable outpatient services Copayment. • Specific diagnostic services, treatment and outpatient prescription drugs Covered at 50% (Member's Cost Share will not exceed GHC's charge). Manipulative Therapy Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for manipulative therapy of the spine and extremities in accordance with GHC clinical criteria up to a maximum of ten (10) visits per Member per calendar year.
Hearing Examinations and Hearing Aids. Hearing examinations to determine hearing loss Covered subject to the applicable outpatient services Copayment. • Hearing aids, including hearing aid examinations Not covered. Home Health Services Covered in full. No visit limit. Hospice Services Covered in full. Inpatient respite care is covered for a maximum of five (5) consecutive days per occurrence. Infertility Services (including sterility) Not covered.
Hearing Examinations and Hearing Aids. Hearing examinations to determine hearing loss Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. • Hearing aids, including hearing aid examinations Not covered. Home Health Services Covered in full. No visit limit. Hospice Services Covered in full. Inpatient respite care is covered for a maximum of five (5) consecutive days per occurrence. Infertility Services (including sterility) • General diagnostic services Covered subject to the lesser of GHC’s charge or the applicable outpatient services Cost Share. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office-based procedures and surgical services. • Specific diagnostic services, treatment and outpatient prescription drugs Covered at 50% (Member’s Cost Share will not exceed GHC’s charge). Manipulative Therapy Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for Self- Referrals to a GHC Provider for manipulative therapy of the spine and extremities in accordance with GHC clinical criteria up to a maximum of ten (10) visits per Member per calendar year. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office-based procedures and surgical services. Maternity and Pregnancy Services • Delivery and associated Hospital Care Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment and at the Plan Coinsurance after the annual Deductible is satisfied. • Prenatal and postpartum care Routine care covered in full. Non-routine care covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. • Pregnancy termination Covered subject to the lesser of GHC’s charge or the applicable Copayment for involuntary/voluntary termination of pregnancy. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. Mental Health Services • Inpatient services Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment and at the Plan Coinsurance at a GHC-approved mental health care facility after the annual Deductible is satisfied. • Outpatien...
Hearing Examinations and Hearing Aids. Hearing exams for hearing loss and evaluation are covered only when provided at KFHPWA-approved facilities. Cochlear implants or Bone Anchored Hearing Aids (BAHA) when in accordance with KFHPWA clinical criteria. Covered services for cochlear implants and BAHA include diagnostic testing, pre-implant testing, implant surgery, post- implant follow-up, speech therapy, programming and associated supplies (such as transmitter cable, and batteries). Hospital - Inpatient: After Deductible, Member pays $100 Copayment per day up to $300 per admission Hospital - Outpatient: After Deductible, Member pays $100 Copayment Outpatient Services: After Deductible, Member pays $10 Copayment for primary care provider services or $20 Copayment for specialty care provider services Hearing aids including hearing aid examinations. Not covered; Member pays 100% of all charges Exclusions: Programs or treatments for hearing loss or hearing care including, but not limited to, externally worn hearing or surgically implanted hearing aids and the surgery and services necessary to implant them except as described above; hearing screening tests required under Preventive Services Home Health Care Home health care when the following criteria are met: • Except for patients receiving palliative care services, the Member must be unable to leave home due to a health problem or illness. Unwillingness to travel and/or arrange for transportation does not constitute inability to leave the home. No charge; Member pays nothing
Hearing Examinations and Hearing Aids. Hearing examinations to determine hearing loss Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment. • Hearing aids, including hearing aid examinations Covered up to a $1,000 maximum per ear during any consecutive thirty-six (36) month period. Home Health Services Covered in full. No visit limit. Hospice Services Covered in full. Inpatient respite care is covered for a maximum of five (5) consecutive days per occurrence. Infertility Services (including sterility) Not covered.
Hearing Examinations and Hearing Aids. Hearing examinations to determine hearing loss MHCN: Covered subject to the lesser of the MHCN’s charge or the applicable outpatient services Copayment and at the Plan Coinsurance after the annual Deductible is satisfied. Community Provider: Covered subject to the lesser of the allowed charge or the applicable outpatient services Copayment and at the Plan Coinsurance after the annual Deductible is satisfied. • Hearing aids, including hearing aid examinations MHCN: Not covered. Community Provider: Not covered. Home Health Services MHCN: Covered in full. No visit limit. Community Provider: Covered at the Plan Coinsurance after the annual Deductible is satisfied. Hospice Services MHCN: Covered in full. Inpatient respite care is covered for a maximum of five (5) consecutive days per occurrence. Community Provider: Covered at the Plan Coinsurance after the annual Deductible is satisfied. Inpatient respite care is covered for a maximum of five (5) consecutive days per occurrence. Preauthorization is required for scheduled hospice admissions, as set forth in Section IV.A. Infertility Services (including sterility) MHCN: Not covered. Community Provider: Not covered. Manipulative Therapy MHCN and Community Provider benefit limits are combined and cannot be duplicated. MHCN: Covered subject to the lesser of the MHCN’s charge or the applicable outpatient services Copayment and at the Plan Coinsurance for Self-Referrals to a MHCN Provider for manipulative therapy of the spine and extremities in accordance with GHO clinical criteria up to a maximum of ten (10) visits per Member per calendar year after the annual Deductible is satisfied. Community Provider: Covered subject to the lesser of the allowed charge or the applicable outpatient services Copayment and at the Plan Coinsurance for manipulative therapy of the spine or extremities up to a maximum of ten
Hearing Examinations and Hearing Aids. Cochlear implants when in accordance with Group Health clinical criteria. Covered services for cochlear implants include implant surgery, pre-implant testing, post-implant follow-up, speech therapy, programming and associated supplies (such as transmitter cable, and batteries). Hearing exams for hearing loss and evaluation and diagnostic testing for cochlear implants are covered only when provided at Group Health-approved facilities. Hospital - Inpatient: Member pays $200 Copayment per day up to $600 per admission and 10% Plan Coinsurance Hospital - Outpatient: Member pays $20 Copayment and 10% Plan Coinsurance Outpatient Services: Member pays $20 Copayment and 10% Plan Coinsurance Hearing aids including hearing aid examinations. Not covered; Member pays 100% of all charges Exclusions: Programs or treatments for hearing loss or hearing care including, but not limited to, externally worn hearing aids or surgically implanted hearing aids and the surgery and services necessary to implant them other than for cochlear implants; hearing screening tests required under Preventive Services Home Health Care
Hearing Examinations and Hearing Aids. Cochlear implants when in accordance with Group Health clinical criteria. Covered services for cochlear implants include implant surgery, pre-implant testing, post-implant follow-up, speech therapy, programming and associated supplies (such as transmitter cable, and batteries). Hearing exams for hearing loss and evaluation and diagnostic testing for cochlear implants are covered only when provided at Group Health-approved facilities. Hospital - Inpatient: No charge; Member pays nothing Hospital - Outpatient: Member pays $10 Copayment Outpatient Services: Member pays $10 Copayment Hearing aids including hearing aid examinations. Not covered; Member pays 100% of all charges Exclusions: Programs or treatments for hearing loss or hearing care including, but not limited to, externally worn hearing aids or surgically implanted hearing aids and the surgery and services necessary to implant them other than for cochlear implants; hearing screening tests required under Preventive Services Home Health Care Home health care when the following criteria are met: The Member is unable to leave home due to his/her health problem or illness. Unwillingness to travel and/or arrange for transportation does not constitute inability to leave the home. The Member requires intermittent skilled home health care, as described below. Group Health’s medical director determines that such services are Medically Necessary and are most appropriately rendered in the Member’s home. Covered Services for home health care may include the following when rendered pursuant to a Group Health- approved home health care plan of treatment: nursing care; No charge; Member pays nothing
