after other services Copayment: $2.00 per have been provided visit Partial Services for people As medically necessary and Hospitalization leaving a hospital recommended by us Services for mental health treatment Physical Physical therapy We cover for children ages Therapy includes exercises , and for adults under the Services stretching and other $1,500 outpatient services treatments to help cap: your body get One initial evaluation per stronger and feel year better after an Up to 210 minutes of injury, illness or treatment per week because of a One initial wheelchair medical condition evaluation per 5 years We cover for people of all ages: Follow-up wheelchair evaluations, one at delivery and one 6-months later Podiatry Medical care and We cover: Services other treatments for Up to 24 office visits per the feet year Foot and nail care X-rays and other imaging for the foot, ankle and lower leg Surgery on the foot, ankle or lower leg Copayment: $2.00 per office visit Prescribed Drug This service is for We cover: Services drugs that are Up to a 34-day supply of prescribed to you by drugs, per prescription a doctor or other Refills, as prescribed health care provider Private Duty Nursing services We cover: Nursing provided in the Up to 24 hours per day Services home to people ages 0 to who need constant care Psychiatric Emergency mental As medically necessary and No Specialty health services that recommended by us
after other services have been provided Copayment: $2.00 per visit Partial Hospitalization Services Services for people leaving a hospital for mental health treatment As medically necessary and recommended by us Physical Therapy Services Physical therapy includes exercises , stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition We cover for children ages and for adults under the $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 Podiatry Services Medical care and other treatments for the feet We cover: Up to 24 office visits per year Foot and nail care X-rays and other imaging for the foot, ankle and lower leg Surgery on the foot, ankle or lower leg Copayment: $2.00 per office visit Prescribed Drug Services This service is for drugs that are prescribed to you by a doctor or other health care provider We cover: Up to a 34-day supply of drugs, per prescription Refills, as prescribed Private Duty Nursing Services Nursing services provided in the home to people ages 0 to who need constant care We cover: Up to 24 hours per day Psychiatric Specialty Emergency mental health services that As medically necessary and recommended by us No
Enrollee_Handbook_Template_For_MMA-and-LTC.docx