These data reflect the most commonly purchased benefits package for each of the health plans in
the year 2000. Coventry/Principal would not supply updated information.

HMO Hospice
Aetna US Healthcare Covers: Hospice for terminally ill member with life expectancy of 6 months or less. Includes home and hospital visits by nurses and social workers, pain management and symptom control. Also includes instruction for family members, inpatient care, counseling and emotional support, and other home health benefits listed in home health section.
Blue Cross Blue Shield Covers: Care of a terminally ill member with a life expectancy of six months or less.

Excludes: Medical care rendered by a doctor, homemaker services such as cooking and housekeeping, food or meals, or private duty nursing services.
CIGNA / Healthsource Covered.

Excludes: meals, housekeeping, and personal convenience or comfort items.
Doctors Health Plan Covers: Hospice if coordinated through Doctors Health Plan.

Excludes: Meals, housekeeping and personal convenience or comfort items.
Generations Covers: Outpatient and inpatient care of a terminally ill member.

Limits: Requires prior approval.

Excludes: Homemaker, volunteer and spiritual counseling services, curative treatment or services, food or home-delivered meals, custodial care, rest care or care for someone’s convenience.
Optimum Choice Covers: Appropriate inpatient or home- based hospice services for a terminally ill member. The participating physician must certify that the patient is in the terminal stages of illness, with a life expectancy of six months or less. Coverage includes supportive services such as inpatient and home based services, and counseling for family members during the member’s illness and bereavement.
PARTNERS Covers: Hospice for members with a prognosis of 6 months or less to live.

Limits: Requires physician direction and advance approval by plan. Limited to 210 days, once per lifetime.

Cost Sharing: Copayments apply.

Excludes: bereavement, pastoral, financial or legal counseling; funeral arrangements; homemaker or caretaker services; respite care.
Coventry/Principal Health Care of the Carolinas Covers: Hospice provided by a state- licensed hospice. The member must, in the judgement of the participating physician, have a life expectancy of six months or less.

Excludes:

  • Health care visits, medical equipment or supplies that are not included in Coventry/Principal’s recommended plan of treatment.
  • Services in the member’s home outside the Coventry/Principal service area.
  • Financial and legal counseling.
  • Any service for which the hospice does not customarily charge the member, or his or her family.
  • Reimbursement for volunteer or spiritual counseling.
QualChoice Covers: Hospice care for terminally ill patients in the home. Also covers hospice provided in a free-standing hospice, a hospice unit within a hospital or skilled nursing facility, or in a regular hospital bed. Coverage includes:
  • Part-time care provided by nurses, licensed practical nurses, or home health aides.
  • Physical therapy, respiratory therapy, and radiation therapy and chemotherapy when required for control of symptoms.
  • Social services.
  • Laboratory examinations, X-rays.
  • Medical supplies, drugs and medications prescribed by a physician.
  • Services provided by the member’s own attending physician or hospice physician.
The Wellness Plan of North Carolina, Inc. Covers: Hospice for terminal conditions that is authorized by the member’s PCP.

Limits: Hospice services are coordinated through TWP-NC‘s case management program. Hospice services are available once per lifetime.
United HealthCare Covered as party of the home health care and skilled nursing facility benefits.
WellPath Covers: Hospice services for terminally ill patients. The PCP must certify that the member has a life expectancy of six months or less and must prepare a written treatment plan authorizing services.

Limits: Coverage is limited to a maximum period of 210 consecutive days, beginning with the first day member receives hospice care, whether at home, in a hospice or other inpatient facility. Coverage of bereavement counseling for family members is limited to a total of 5 visits per family.

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