I. Home Health Services Coverage is limited to skilled nursing services only. Five dollars ($5.00) per Includes prescribed home visits by housekeeping and personal comfort items are excluded. both registered and licensed practical Services must be provided directly by INSURER. nurses to provide skilled nursing services on a part-time intermittent Private duty nursing is limited to circumstances such care is basis. medically appropriate. J. Hospice Services Services required for conditions totally unrelated to the terminal condition Five dollars ($5.00) per are covered to the extent that such services are otherwise covered under visit. Covered services include reasonable this contract. and necessary services for palliation or management of an Enrollee’s terminal illness. All admissions must be authorized by INSURER and provided by an NONE INSURER affiliated facility. K. Nursing Facility Services Participant must require and receive skilled services on a daily basis as Covered services include regular ordered by an INSURER physician. nursing services, rehabilitation services, drugs and biologicals, The length of the Enrollee’s stay shall be determined by the medical medical supplies, and the use of condition of the Enrollee in relation to the necessary and appropriate appliances and equipment furnished level of care, but may be no more than one hundred (100) days per by the facility. contract year. Room and board is limited to semi-private accommodations unless a private room is considered medically necessary or semi-private accommodations are not available. Specialized treatment centers and independent kidney disease treatment centers are excluded. Private duty nurses, television, and custodial care are excluded .Admissions for rehabilitation and physical therapy are limited to fifteen (15) days per contract year. L. Durable Medical Equipment and Equipment and devices must be provided by authorized INSURER NONE Prosthetic supplier. Devices Covered prosthetic devices include artificial eyes, braces and other Equipment and devices that are artificial aids. medically indicated to assist in the treatment of a medical condition and Low vision and telescopic lenses are not included. specifically prescribed as medically necessary by Enrollee’s INSURER Hearing aids are covered only when medically indicated to assist in the physician. treatment of a medical condition.
I. Home Health Services Includes prescribed home visits by both registered and licensed practical nurses to provide skilled nursing services on a part-time intermittent basis. Coverage is limited to skilled nursing services only. housekeeping and personal comfort items are excluded. Services must be provided directly by INSURER. Private duty nursing is limited to circumstances such care is medically appropriate. Five dollars ($5.00) per J. Hospice Services Covered services include reasonable and necessary services for palliation or management of an Enrollee’s terminal illness. Services required for conditions totally unrelated to the terminal condition are covered to the extent that such services are otherwise covered under this contract. Five dollars ($5.00) per visit. K. Nursing Facility Services Covered services include regular nursing services, rehabilitation services, drugs and biologicals, medical supplies, and the use of appliances and equipment furnished by the facility. All admissions must be authorized by INSURER and provided by an INSURER affiliated facility. Participant must require and receive skilled services on a daily basis as ordered by an INSURER physician. The length of the Enrollee’s stay shall be determined by the medical condition of the Enrollee in relation to the necessary and appropriate level of care, but may be no more than one hundred (100) days per contract year. Room and board is limited to semi-private accommodations unless a private room is considered medically necessary or semi-private accommodations are not available. Specialized treatment centers and independent kidney disease treatment centers are excluded. Private duty nurses, television, and custodial care are excluded .Admissions for rehabilitation and physical therapy are limited to fifteen (15) days per contract year. NONE L. Durable Medical Equipment and Prosthetic Devices Equipment and devices that are medically indicated to assist in the treatment of a medical condition and specifically prescribed as medically necessary by Enrollee’s INSURER physician. Equipment and devices must be provided by authorized INSURER supplier. Covered prosthetic devices include artificial eyes, braces and other artificial aids. Low vision and telescopic lenses are not included. Hearing aids are covered only when medically indicated to assist in the treatment of a medical condition. NONE
Revised-Draft-ITN-Contract-Draft-B.docx