Ambulance Ambulance services Covered as medically Transportation are for when you necessary. Services need emergency care while being transported to the hospital or special support when being transported between facilities Ambulatory Services provided As medically necessary and Detoxification to people who are recommended by us Services withdrawing from drugs or alcohol Ambulatory Surgery and other Covered as medically Surgical Center procedures that are necessary. Services performed in a facility that is not the hospital (outpatient) Anesthesia Services to keep Covered as medically Services you from feeling necessary. pain during surgery or other medical procedures Assistive Care Services provided We cover 365/366 days of Services to adults (ages 18 services per year, and older) help with activities of daily living and taking medication Behavioral Services used to We cover: Health detect or diagnose One initial assessment per Assessment mental illnesses year Services and behavioral One reassessment per health disorders year Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day) Copayment: $2.00 per visit Behavioral Behavioral health We cover 365/366 days of Health Overlay services provided to services per year, including Services children (ages 0 therapy, support services and – aftercare planning
Ambulance Transportation Services Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities Covered as medically necessary. Ambulatory Detoxification Services Services provided to people who are withdrawing from drugs or alcohol As medically necessary and recommended by us Ambulatory Surgical Center Services Surgery and other procedures that are performed in a facility that is not the hospital (outpatient) Covered as medically necessary. Anesthesia Services Services to keep you from feeling pain during surgery or other medical procedures Covered as medically necessary. Assistive Care Services Services provided to adults (ages 18 and older) help with activities of daily living and taking medication We cover 365/366 days of services per year, Behavioral Health Assessment Services Services used to detect or diagnose mental illnesses and behavioral health disorders We cover: One initial assessment per year One reassessment per year Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day) Copayment: $2.00 per visit Behavioral Health Overlay Services Behavioral health services provided to children (ages 0 – We cover 365/366 days of services per year, including therapy, support services and aftercare planning
Enrollee_Handbook_Template_For_MMA-and-LTC.docx