Common use of HOSPITAL VISITS Clause in Contracts

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), Physician Assistant Anesthetists (PAA), and Athletic Trainers (LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Contract’s Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber and any eligible female Dependent. Routine newborn nursery care is part of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 hours following a normal delivery or 96 hours following a cesarean section delivery, the Member will have access to two post- discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), Physician Assistant Anesthetists (PAA), and Athletic Trainers (LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Contract’s any applicable Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber Employee and any eligible female Dependent. Routine newborn nursery care is part of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 48- hours following a normal delivery or 96 96- hours following a cesarean section delivery, the Member will have access to two post- discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are also payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), and Physician Assistant Anesthetists (PAA), and Athletic Trainers (LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES A Prior Authorization is required for visits. Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Developmental Delay will be covered when it is more than two standard deviations from the norm as defined by standardized, validated developmental screening tests such as the Denver Developmental Screening Test. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Contract’s Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber and any eligible female Dependent. Routine newborn nursery care is part of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 hours following a normal delivery or 96 hours following a cesarean section delivery, the Member will have access to two post- post-discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), Physician Assistant Anesthetists (PAA), and Athletic Trainers (LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Contract’s any applicable Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber Employee and any eligible female Dependent. Routine newborn nursery care is part of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 48-hours following a normal delivery or 96 96-hours following a cesarean section delivery, the Member will have access to two post- discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are also payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), and Physician Assistant Anesthetists (PAA), and Athletic Trainers (LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Contract’s any applicable Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber Employee and any eligible female Dependent. Routine newborn nursery care is part of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 48- hours following a normal delivery or 96 96- hours following a cesarean section delivery, the Member will have access to two post- discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), Physician Assistant Anesthetists (PAA), and Athletic Trainers (LATTrainers(LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. .Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Your Contract’s Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber and any eligible female Dependent. Routine newborn nursery care is part ispart of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 hours following a normal delivery or 96 hours following a cesarean section delivery, the Member will have access to two post- discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.

HOSPITAL VISITS. The Physician’s visits to his or her patient in the Hospital. Covered Services are generally limited to one daily visit for each Physician during the covered period of confinement. LICENSED MID-LEVEL PROVIDERS Benefits are also payable for Covered Services provided by licensed mid-level providers. Such providers include, but are not limited to, Nurse Practitioners (NP), Physician Assistant (PA), and Physician Assistant Anesthetists (PAA), and Athletic Trainers (LAT) when performing services within their scope of practice as defined by the state of Georgia. LICENSED SPEECH THERAPIST SERVICES Services must be ordered and supervised by a Physician as outlined in the Summary of Benefits and Coverage. Services will be covered only to treat or promote recovery of the specific functional deficits identified. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. MATERNITY CARE (PRE AND POST NATAL CARE) Covered Services include Maternity Care on the same basis as for any other type of care, subject to your Contract’s Copayment, Deductible and Coinsurance provisions. Maternity benefits are provided for a female Subscriber and any eligible female Dependent. Routine newborn nursery care is part of the mother’s maternity benefits. Should the newborn require other than routine nursery care, the baby will be admitted to the Hospital in his or her own name (see “Changing Your Coverage” to add coverage for a newborn). Under federal law, the Contract may not restrict the length of stay to less than the 48-hour or 96-hour period or require Prior Authorization for either length of stay. The length of hospitalization which is Medically Necessary will be determined by the Member’s attending Physician in consultation with the mother. Should the mother or infant be discharged before 48 hours following a normal delivery or 96 hours following a cesarean section delivery, the Member will have access to two post- discharge follow-up visits within the 48-hour or 96-hour period. These visits may be provided either in the Physician’s office or in the Member’s home by a Home Health Care Agency. The determination of the medically appropriate place of service and the type of provider rendering the service will be made by the Member’s attending Physician. For In-Network Physician’s care for prenatal care visits, delivery and postpartum visit(s), only one Copayment (if applicable) will be charged.