HMO COVERAGE OF SPECIFIC SERVICES

HOSPITAL CARE
Inpatient Services
Outpatient Services
Emergency Care
Urgent Care
Ambulance

Care for Students Outside Service Area
Non-Urgent Care Use Outside Service Area

PROFESSIONAL SERVICES
Professional Services (general)
OB/GYN
Diagnostic Procedures
Therapeutic Treatment Services
Allergy Testing and Treatment

PREVENTIVE SERVICES
Annual Physicals (Well-Baby, Well-Child)
Immunizations
Preventive Clinical Services
Other Health Promotion/Disease Prevention Activities
Diabetic Treatment

CONCEPTION SERVICES
Prenatal and Obstetrical Services
Family Planning
Abortion
Infertility Services

MENTAL/BEHAVIORAL AND ADDICTION SERVICES
Mental Health Inpatient
Mental Health Outpatient
Substance Abuse Inpatient
Substance Abuse Outpatient

PRESCRIPTION DRUGS AND MEDICAL SUPPLIES
Prescription Drugs
Blood
Medical Supplies
Insulin and Diabetic Supplies

DURABLE MEDICAL EQUIPMENT, PROSTHETICS AND ORTHOTICS
Durable Medical Equipment
Prosthetic Appliances
Orthotic Devices

REHABILITATIVE SERVICES
Physical Therapy
Occupational Therapy
Speech Therapy
Pulmonary Therapy
Chiropractic
Cardiac Rehabilitation
Other Therapy Services
Skilled Nursing Facility

HOME BASED SERVICES
Home Health
Private Duty Nursing
Hospice

TRANSPLANT AND DIALYSIS
Transplants
Dialysis

OTHER SERVICES
Dental
Vision
Hearing
Foot Care
Weight Loss
Smoking Cessation
Growth Hormones
Alternative Therapies
Reconstructive/Cosmetic Surgery
Non-Emergency Transportation

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