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

INDEX

UNDERSTANDING
MANAGED CARE

CONSUMER PROTECTIONS

MEMBER RESPONSIBILITIES

QUESTIONS TO
ASK YOUR PLAN

QUESTIONS TO
ASK YOUR PLAN:
PEOPLE WITH
SPECIAL HEALTH NEEDS

BACKGROUND
INFORMATION: NC HMOS

HOW TO INTERPRET
THE INFORMATION

HMO COVERAGE OF SPECIFIC SERVICES

COMMON EXCLUSIONS

ENROLLMENT TRENDS

DISENROLLMENT TRENDS

UTILIZATION REVIEW INFORMATION

FINANCIAL DATA

GLOSSARY

INTERNET RESOURCES

INTERNET RESOURCES:
INDIVIDUALS WITH DISABILITIES

STATE FUNDED HEALTH PROGRAMS FOR
YOUNG CHILDREN
AND THEIR FAMILIES

NC DEPARTMENT
OF INSURANCE

NC STATE EMPLOYEES
HEALTH PLAN

NC DEPARTMENT OF MEDICAL
ASSISTANCE (MEDICAID)

NC HEALTHCHOICE

NC COUNCIL ON DEVELOPMENTAL
DISABILITIES

MEDICARE

YOUR COMMENTS

NORTH CAROLINA
INSTITUTE OF MEDICINE