Day Rehabilitation Program A level of Outpatient Care consisting of four to seven hours of daily rehabilitative therapies and other medical services five days per week. The Member returns home: Each evening; and For the entire weekend. Therapies provided may include a combination of therapies, such as: Physical Therapy; Occupational Therapy; and Speech Therapy. Other medical services such as: Nursing services; Psychological therapy; and Case Management services. Day Rehabilitation sessions also include a combination of: One-to-one therapy; and Group therapy. Decision Support Services that help Members make well-informed decisions about Health care and support their ability to follow their Provider's treatment plan. Some examples of support services are: Major treatment choices; and Every day health choices. Deductible A specified amount of Covered Expense for the Covered Services that is Incurred, by the Member, before the Claims Administrator will assume any liability. A specific dollar amount that the Member's Claims Administrator may require that the Member pay out-of pocket each Benefit Period, before the Program begins to make payments for claims. Detoxification The process by which a person who is alcohol or drug intoxicated, or alcohol or drug dependent, is assisted under the following circumstances: In a state licensed Facility Provider; or In the case of opiates, by an appropriately licensed behavioral health provider, in an ambulatory (Outpatient) setting. This treatment process will occur through the period of time necessary to eliminate, by metabolic or other means, any or each of the following problems: The intoxicating alcohol or drug; Alcohol or drug dependency factors; or Alcohol in combination with drugs, as determined by a licensed Physician, while keeping the physiological and psychological risk to the patient at a minimum.
Day Rehabilitation Program A level of Outpatient Care consisting of four to seven hours of daily rehabilitative therapies and other medical services five days per week. The Member returns home: Each evening; and For the entire weekend. Therapies provided may include a combination of therapies, such as: Physical Therapy; Occupational Therapy; and Speech Therapy. Other medical services such as: Nursing services; Psychological therapy; and Case Management services. Day Rehabilitation sessions also include a combination of: One-to-one therapy; and Group therapy. Decision Support Services that help Members make well-informed decisions about Health care and support their ability to follow their Provider's treatment plan. Some examples of support services are: Major treatment choices; and Every day health choices. Deductible A specified amount of Covered Expense for the Covered Services that is Incurred, by the Member, before the Claims Administrator will assume any liability. A specific dollar amount that the Member's Claims Administrator may require that the Member pay out-of pocket each Benefit Period, before the Program begins to make payments for claims. Detoxification The process by which a person who is alcohol or drug intoxicated, or alcohol or drug dependent, is assisted under the following circumstances: In a state licensed Facility Provider; or In the case of opiates, by an appropriately licensed behavioral health provider, in an ambulatory (Outpatient) setting. This treatment process will occur through the period of time necessary to eliminate, by metabolic or other means, any or each of the following problems: The intoxicating alcohol or drug; Alcohol or drug dependency factors; or Alcohol in combination with drugs, as determined by a licensed Physician, while keeping the physiological and psychological risk to the patient at a minimum.
03-2016-ST%239.IBC.PPOBOOKLET10093739-92.030916-15-000193-AJGW.docx