Extended Care Services. Covered Services include the following when prescribed by the PCP and authorized by the HMO. Services may have additional limitations as indicated on the Schedule of Copayments and Benefit Limits, and restrictions or exclusions described in Limitations and Exclusions. Skilled Nursing Facility Services. Services must be temporary and lead to rehabilitation and an increased ability to function. Custodial Care is not covered. If You remain in a Skilled Nursing Facility after the PCP discharges You or after You reach the maximum benefit period or period authorized by HMO, You will be liable for all subsequent costs incurred. Hospice Care. Care that is provided by a Hospital, Skilled Nursing Facility, Hospice, or a duly licensed Hospice Care agency, is approved by HMO, and is focused on a palliative rather than curative treatment for Members who have a medical condition and a prognosis of less than 6 months to live. Home Health Care. Care in the home by Health Care Professionals who are Participating Providers, including but not limited to registered nurses, licensed practical nurses, physical therapists, inhalation therapists, speech or hearing therapists or home health aides. Services must be provided or arranged by the PCP. Health Maintenance and Preventive Services Covered Services, which may require Preauthorization, include:
Extended Care Services. Covered Services include the following when prescribed by the PCP and authorized by the HMO. Services may have additional limitations, as indicated on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and restrictions or exclusions described in LIMITATIONS AND EXCLUSIONS. Skilled Nursing Facility Services. Services must be temporary and lead to rehabilitation and an increased ability to function. Custodial Care is not covered. If You remain in a Skilled Nursing Facility after the PCP discharges You or after You reach the maximum benefit period or period authorized by HMO, You will be liable for all subsequent costs incurred. Hospice Care. Care that is provided by a Hospital, Skilled Nursing Facility, Hospice, or a duly licensed Hospice Care agency, is approved by HMO, and is focused on a palliative rather than curative treatment. Services include bereavement counseling. For care provided in a Hospital, charges described in Inpatient Hospital Services will apply. Home Health Care. Care in the home by Health Care Professionals who are Participating Providers, including but not limited to registered nurses, licensed practical nurses, physical therapists, inhalation therapists, speech or hearing therapists or home health aides. Services must be provided or arranged by the PCP. Health Maintenance and Preventive Services Covered Services, which may require Prior Authorization and will not be subject to any Copayment or dollar maximums, include evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (“USPSTF”) or as required by state law. The services listed below may include requirements pursuant to state regulatory mandates and are to be covered at no cost to the Member:
Extended Care Services. Extended Care Hours are 7:00 AM-8:30 AM and 3:30 PM-6:00 PM
Extended Care Services. Covered Services include the following when prescribed by the PCP and authorized by the HMO. Services may have additional limitations, as indicated on the Schedule of Copayments and Benefit Limits and restrictions or exclusions described in Limitations and Exclusions. Skilled Nursing Facility Services. Services must be temporary and lead to rehabilitation and an increased ability to function. Custodial Care is not covered. If You remain in a Skilled Nursing Facility after the PCP discharges You or after You reach the maximum benefit period or period authorized by HMO, You will be liable for all subsequent costs incurred. Hospice Care. Care that is provided by a Hospital, Skilled Nursing Facility, Hospice, or a duly licensed Hospice Care agency, is approved by HMO, and is focused on a palliative rather than curative treatment for Members who have a medical condition and a prognosis of less than 6 months to live. Services include bereavement counseling. Home Health Care. Care in the home by Health Care Professionals who are Participating Providers, including but not limited to registered nurses, licensed practical nurses, physical therapists, inhalation therapists, speech or hearing therapists or home health aides. Services must be provided or arranged by the PCP. Health Maintenance and Preventive Services Covered Services, which may require Preauthorization and will not be subject to any Copayment or dollar maximums, include evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (“USPSTF”) or as required by state law:
