Home Health Care Benefits. Benefits are provided for home health care ser- vices from a Participating home health care agency when the services are ordered by the Member’s Physician, and included in a written treatment plan. Services by a Non-Participating home health care agency, shift care, private duty nursing and stand- alone health aide services must be prior authorized by Blue Shield. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers will be payable up to a combined per Member per Calendar Year visit maximum as shown on the Summary of Bene- fits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maximum (including all home health visits) by any of the following professional providers:
Home Health Care Benefits. Home health care agency services (Including home visits by a nurse, home health aide, medical social worker, physical therapist, speech therapist or occupational thera- pist) Up to a maximum of 100 visits per Member, per Calendar Year, by home health care agency providers. If your benefit Plan has a Calendar Year Medical Deductible, the number of visits starts counting toward the maximum when services are first provided even if the Calendar Year Medical Deductible has not been met. $20 per visit Medical supplies You pay nothing Home Infusion/Home Injectable Therapy Benefits Hemophilia home infusion services Services provided by hemophilia infusion providers and prior au- thorized by Blue Shield. Includes blood factor product. You pay nothing
Home Health Care Benefits. Benefits are provided for home health care ser- vices when ordered and authorized through the Member’s Primary Care Physician. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers are covered up to the combined per Member per Calendar Year visit maximum as shown on the Summary of Ben- efits. Injectable Therapy Benefit or under the Supplemen- tal Benefit for Outpatient Prescription Drugs if se- lected as an optional Benefit by your Employer. Skilled services provided by a home health agency are limited to a combined visit maximum as shown in the Summary of Benefits per Member per Calen- dar Year for all providers other than Plan Physicians. See the Hospice Program Benefits section for in- formation about admission into a Hospice program and specialized Skilled Nursing services for Hos- pice care. For information concerning diabetic self-manage- ment training, see the Diabetes Care Benefits sec- tion. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maxi- mum. The visit maximum includes all home health visits by any of the following professional providers:
Home Health Care Benefits. The Plan covers charges for home health care made by a Home Health Care Agency, provided that the Home Health Care Plan: • Is prescribed by a Physician; • Is reviewed and approved by the Physician every two weeks; and • Contains a statement expressing the belief of the Physician and Home Health Care Agency that the: − Number of days of home health care does not exceed the number of days of confinement in a Hospital or nursing home that would have been required; − Home health care will cost less per day than the daily rate for confinement in a Hospital or nursing home; and − Confinement in a Hospital or nursing home would otherwise be required. Home health care does not include housekeeping or custodial care. The Plan covers TMJ expenses for surgical procedures only. The MAP is administered by an organization of medical psychologists, social workers, and counselors who provide confidential professional assistance. A copy of the Home Health Care Plan must be provided to the agency. Home health care includes: • Skilled nursing care and home health aide services; and • Any other services and supplies provided instead of the services, which would have been covered under the Plan, if the Employee were confined in a Hospital or nursing home. DENTAL BENEFITS The Plan provides dental benefits in certain circumstances, including: • Charges for the surgical extraction of impacted wisdom teeth and related anesthesia administered for the procedure. • Dental services for the treatment of an Injury to the jaw or natural teeth, including X-rays, within six months. These services will be covered the same as for medical expenses related to an accident/Injury. TEMPOROMANDIBULAR JOINT (TMJ) DYSFUNCTION BENEFITS The Plan covers TMJ expenses if the covered individual is advised by a Physician or surgeon to have a surgical procedure performed for the treatment of temporomandibular joint (TMJ) dysfunction, including associated myofacial repair, mandibular or maxillar osteototomy or any related surgery. However, the Fund requires that the individual obtain a second surgical opinion. The Fund will pay 100% of the expenses incurred for such second surgical opinion relating to the Medical Necessity for surgery (including x-rays and laboratory services) and no Plan deductibles will apply. The Physician or surgeon rendering the second surgical opinion may be chosen by the covered individual, provided the Physician or surgeon satisfies the conditions listed in the following “Confirming ...
Home Health Care Benefits. Benefits are provided for home health care ser- vices from a Participating home health care agency when the services are ordered by the Member’s Physician, and included in a written treatment plan. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers will be payable up to a combined per Member per Calendar Year visit maximum as shown on the Summary of Bene- fits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maximum (including all home health visits) by any of the following professional providers:
Home Health Care Benefits. Benefits are provided for home health care ser- vices when ordered and authorized through the Member’s Primary Care Physician. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers are covered up to the combined per Member per Calendar Year visit maximum as shown on the Summary of Ben- efits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maxi- mum. The visit maximum includes all home health visits by any of the following professional providers:
Home Health Care Benefits. Benefits are provided for home health care Services when the Services are Medically Necessary, ordered by the Personal Physician, and authorized. Visits by home health care agency providers are limited to a combined visit maximum during any Calendar Year as shown in the Summary of Benefits. Intermittent and part-time home visits by a home health agen- cy to provide Skilled Nursing Services and other skilled Ser- vices are covered up to 4 visits per day, 2 hours per visit not to exceed 8 hours per day by any of the following professional providers:
Home Health Care Benefits. In-Network, the Medical Plan shall pay ninety percent (90%) of expenses for up to sixty (60) home health care visits per calendar year, after $50 of the $200 deductible has been satisfied. Out-of-Network, the Medical Plan shall pay seventy percent (70%) of expenses for up to sixty (60) home health care visits per calendar year, after the full deductible has been satisfied.
Home Health Care Benefits. Services Provided at a Non-Plan Hospital Following Stabilization of an Emergency Medical Condition When the Member’s Emergency Medical Condition is stabilized, and the treating health care provider at the non-Plan Hospital believes additional Medically Necessary Hospital services are required, the non- Plan Hospital must contact Blue Shield to obtain timely authorization. Blue Shield may authorize con- tinued Medically Necessary Hospital services by the non-Plan Hospital. If Blue Shield determines the Member may be safely transferred to a Hospital that is contracted with the Plan and the Member refuses to consent to the trans- fer, the non-Plan Hospital must provide the Member with written notice that the Member will be xxxxx- cially responsible for 100% of the cost for services provided following stabilization of the Emergency Medical Condition. As a result, the Member may be billed by the non-Plan Hospital. Members should contact Customer Service at the number provided on the back page of the EOC for questions regarding im- proper billing for services received from a non-Plan Hospital. For information on Emergency Services received outside of California, see the Inter-Plan Arrange- ments section of the EOC. Family Planning and Infertility Benefits Benefits are provided for the following fam- ily planning services without illness or injury be- ing present:
Home Health Care Benefits. Services Provided at a Non-Plan Hospital Following Stabilization of an Emergency Medical Condition When the Member’s Emergency Medical Condition is stabilized, and the treating health care provider at the non-Plan Hospital believes additional Medically Necessary Hospital services are required, the non- Plan Hospital must contact Blue Shield to obtain timely authorization. Blue Shield may authorize con- tinued Medically Necessary Hospital services by the non-Plan Hospital. If Blue Shield determines the Member may be safely transferred to a Hospital that is contracted with the Plan and the Member refuses to consent to the trans- fer, the non-Plan Hospital must provide the Member with written notice that the Member will be xxxxx- cially responsible for 100% of the cost for services provided following stabilization of the Emergency Medical Condition. As a result, the Member may be Benefits are provided for home health care ser- vices when ordered and authorized through the Member’s Primary Care Physician. Covered Services are subject to any applicable De- ductibles, Copayments and Coinsurance. Visits by home health care agency providers are covered up to the combined per Member per Calendar Year visit maximum as shown on the Summary of Ben- efits. Intermittent and part-time visits by a home health agency to provide Skilled Nursing and other skilled services are covered up to four visits per day, two hours per visit up to the Calendar Year visit maxi- mum. The visit maximum includes all home health visits by any of the following professional providers:
