you do things in $1,500 outpatient services your daily life, like cap: writing, feeding One initial evaluation per yourself, and using year items around the Up to 210 minutes of house treatment per week One initial wheelchair evaluation per 5 years We cover for people of all ages: Follow-up wheelchair evaluations, one at delivery and one 6-months later Oral Surgery Services that Covered as medically Services provide teeth necessary extractions Copayment: $2.00 per (removals) and to office visit treat other conditions, illnesses or diseases of the mouth and oral cavity Orthopedic Services to Covered as medically Services diagnose or treat necessary conditions, illnesses Copayment: $2.00 per or diseases of the office visit bones or joints Outpatient Medical care that Hospital you get while you Emergency services are Services are in the hospital covered as medically but are not staying necessary overnight. This can Non-emergency services include any tests, cannot cost more than medicines, $1,500 per year for therapies and recipients ages 21 and treatments, visits over from doctors and Copayment: $15.00 or equipment that is less for non-emergency used to treat you services at an emergency room and $3.00 for all others Pain Treatments for Covered as medically Management pain that necessary. Some service Services does not get better limits may apply
you do things in your daily life, like writing, feeding yourself, and using items around the house $1,500 outpatient services cap: One initial evaluation per year Up to 210 minutes of treatment per week One initial wheelchair evaluation per 5 years We cover for people of all ages: Follow-up wheelchair evaluations, one at delivery and one 6-months later Oral Surgery Services Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity Covered as medically necessary Copayment: $2.00 per office visit Orthopedic Services Services to diagnose or treat conditions, illnesses or diseases of the bones or joints Covered as medically necessary Copayment: $2.00 per office visit Outpatient Hospital Services Medical care that you get while you are in the hospital but are not staying overnight. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you Emergency services are covered as medically necessary Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over Copayment: $15.00 or less for non-emergency services at an emergency room and $3.00 for all others Pain Management Services Treatments for pain that does not get better Covered as medically necessary. Some service limits may apply
Enrollee_Handbook_Template_For_MMA-and-LTC.docx