• Skilled nursing services for a homebound member. Treatment must be provided by or supervised by an RN.
• Services of a home health aide when the purpose of the treatment is skilled care. Treatment must be supervised by an RN.
• Medical social services provided along with other home health services. The PCP must certify that such services are necessary for the treatment of member’s medical condition.

Limits: Services must be provided by a home health agency in lieu of a hospitalization. In addition, services must be approved and arranged in advance by HMO. HMO shall not be required to provide home health benefits when it determines the treatment setting is not appropriate or when there is a more cost effective setting in which to provide appropriate care.

Excludes: Custodial or care that does not require the continuing attention of trained medical or paramedical personnel.

Limits: Limited to a maximum of 60 days per calendar year per member. prior approval is required.

Cost Sharing: Copayment applies.

Limits: Visit limits apply.

Excludes: meals, housekeeping, and personal convenience or comfort items.

Limits: Nursing services are covered in full for up to 60 days per contract year. Doctors’ case management program will authorize benefits in cases where it is clinically appropriate and where significant improvement can be expected. Requires precertification or prior authorization from Doctors. Must be provided by participating provider or facility unless there is no participating provider available.

Excludes: meals, housekeeping and personal convenience or comfort items.

Excludes: Meals, housekeeping, personal convenience or comfort items.

Limits: Home health services limited up to 35 hours week for a period not to exceed 21 days.

Cost Sharing: Copayment for a home visit by a PCP, specialist, or affiliate provider will apply.

Excludes:

• Custodial care
• Convenience items
• Non-medical services

Limits: Coverage limited to 100 days per spell of illness for SNF and home health services combined if approved in advance by the plan. Coverage limited to members who are confined to home. Physical and speech therapy services are subject to limitations previously listed.

Excludes: Custodial and respite care.

• The services can only be performed by a licensed nurse, physical therapist, speech therapist, or occupational therapist.
• Services must be a substitute for hospitalization.
• Part-time intermittent services are needed.
• A treatment plan has been established and periodically reviewed by the ordering physician.

• The agency providing the services is Medicare certified and licensed by the state of location. Coventry/Principal must authorize the services.

• Intermittent home nursing by a registered nurse or nurses aide when medically appropriate.
• Physical, occupational, or speech therapy if provided through a Home Health Care Agency.
• Skilled treatments done by licensed or certified Home Health Care Agency personnel, including non-prescription medical supplies such as surgical dressings and saline solutions.

Limits: Services must be provided in a member’s home for the care and treatment of an injury or sickness which otherwise might require inpatient confinement. Services will only be covered if directed by a participating physician, approved in advance by UHC, and obtained through a UHC selected provider.

Excludes: Maintenance or custodial care.

Limits: Services must be provided by a participating provider. Must have been referred by a participating provider and approved in advance by WellPath.

Cost Sharing: Copayment may apply for participating physician services at home. There is no copayment for home health care.

Excludes: Plan does not cover custodial care or care for persistent illness and disorders.