Inpatient. In accordance with Rhode Island General Law §27-20-17.1, this agreement covers a minimum inpatient hospital stay of forty- eight (48) hours from the time of a vaginal delivery and ninety-six (96) hours from the time of a cesarean delivery: • If the delivery occurs in a hospital, the hospital length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple births, at the time of the last delivery). • If the delivery occurs outside a hospital, the hospital length of stay begins at the time the mother or newborn is admitted as a hospital in connection with childbirth. Any decision to shorten these stays shall be made by the attending physician in consultation with and upon agreement with you. In those instances where you and your infant participate in an early discharge, you will be eligible for: • up to two (2) home care visits by a skilled, specially trained registered nurse for you and/or your infant, (any additional visits must be reviewed for medical necessity); and • a pediatric office visit within twenty-four (24) hours after discharge. See Section 3.23 - Office Visits for coverage of home and office visits. We cover hospital services provided to you and your newborn child. Your newborn child is covered for services required to treat injury or sickness. This includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities as well as routine well-baby care.
Inpatient. If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section 3.20 – Inpatient Hospital Services for additional information. Preauthorization is recommended for inpatient mental health services.
Inpatient. We cover inpatient drugs as a hospital service. See Glossary for definition of hospital services. Outpatient/In Your Doctor’s Office/In Your Home Generic, preferred brand name, or non-preferred brand name prescription drugs are covered at different benefit levels depending upon the route of administration. Our allowance for services rendered by the facilities, agencies, and professional providers may include the cost of the prescription drugs administered and/or dispensed. We will determine coverage based upon the route of administration that is customary and least invasive method to treat the condition. There are several ways to administer drugs into the body including: inhalation (into the lungs, usually through the mouth); intramuscular (injected into a muscle); intra-articular (injected into a skeletal joint space); intrathecal (injected into the space around the spinal cord); intravenous/infused/intra-arterial (into a vein or artery); nasal (sprayed into the nose); ocular (instilled in the eye); oral (by mouth); rectal or vaginal (inserted into the rectum or vagina); subcutaneous (injected beneath the skin); sublingual (under the tongue); topical (applied to the skin); OR transdermal (delivered through the skin by a patch). Inhalation, Nasal, Ocular, Oral, Rectal Or Vaginal, Sublingual, Topical, And Transdermal Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs The prescription drug is included in our allowance for the medical service being rendered. If the sole service is drug dispensing, the prescription drug is NOT covered. Injected Generic, Preferred Brand Name or Non-Preferred Brand Name Prescription Drugs We use the term injected to include prescription drugs approved by us given by intra muscular or subcutaneous injection or in the case of a body cavity by instillation. See the Summary of Medical Benefits for benefit limits and the amount that you pay. See Prevention and Early Detection Services section for immunization and vaccination coverage information. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.
Inpatient. Radiation therapy and chemotherapy services are covered as a hospital service. See Section 8.0 - definition of hospital services. Outpatient/In a Doctor's Office Radiation Therapy We cover hospital and doctor services for outpatient radiation therapy. Radiation physics, dosimetry services, treatment devices, and hospital services are included in radiation treatment planning and therapy and are covered as part of our allowance for radiation therapy. Chemotherapy Services This agreement covers the doctor’s administration fee and associated hospital supplies. In Your Home Radiation Therapy This agreement does NOT cover radiation treatment services received in your home. Chemotherapy Services This agreement covers the doctor’s administration fee
Inpatient. Medically necessary inpatient physical or occupational therapy is covered as a hospital service. See Section 8.0.
Inpatient. If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section 3.20 – Inpatient Hospital services for additional information. Preauthorization is recommended for inpatient mental health services. Intermediate Care Services Intermediate Care Services are facility based programs used as a step down from a higher level of care or a step-up from standard care. See the Summary of Medical Benefits for the amount you pay. Preauthorization is recommended for intermediate care services. This agreement covers the following mental health Intermediate Care Services: Partial Hospital Program (PHP) – This agreement covers partial hospital programs that are approved by us and meets our criteria for participation and program requirements.
Inpatient. This agreement covers inpatient hospital and skilled nursing facility speech therapy as a hospital service. See Section 8.0 definition of hospital services. Outpatient /In a Doctor’s/Therapist’s Office This agreement will cover speech therapy services when received from a registered therapist as part of a formal treatment plan for: speech or communication function loss; impairment as a result of an acute illness or injury; an acute exacerbation of chronic disease; the development of a new speech or communication skill; and such improvement will not diminish with the removal of the therapeutic agent or environment. Speech therapy services must relate to: performing basic functional communication; or assessing or treating swallowing dysfunction. Some services rendered by a speech therapist are classified as diagnostic tests. See Section 3.35 – Tests, Imaging, and Labs and the Summary of Medical Benefits for benefit limits and the amount that you pay. In Your Home This agreement does NOT cover speech therapy services received in your home, unless it is part of a home care program.