Additional Home Health Care Benefits. A. Home Visits Following Surgical Removal of a Testicle For a Member who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, benefits will be provided for: 1. One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and 2. An additional home visit if prescribed by the Member’s attending Contracting Physician. 3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. 4. Prior authorization is not required. B. Home Visits Following a Mastectomy 1. For a Member who has a shorter hospital stay than that provided under Section 5.2.B, Inpatient Coverage Following a Mastectomy, or who undergoes a Mastectomy on an outpatient basis, benefits will be provided for: a) One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and SAMPLE b) An additional home visit if prescribed by the Member’s attending Contracting Physician. 2. For a Member who remains in the hospital for at least the length of time provided in Section 5.2.B, Inpatient Coverage Following a Mastectomy, coverage will be provided for a home visit if prescribed by the Member’s attending Contracting Physician. 3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. 4. Prior authorization is not required. C. Postpartum Home Visits Home visits following delivery are covered in accordance with the most current standards published by the American College of Obstetricians and Gynecologists. 1. For a mother and newborn child who have a shorter hospital stay than that provided under Section 5.2.D, Childbirth, benefits will be provided for: a) One home visit scheduled to occur within 24 hours after hospital discharge; and b) An additional home visit if prescribed by the attending Contracting Physician. 2. For a mother and newborn child who remain in the hospital for at least the length of time provided under Section 5.2.D, Childbirth, benefits will be provided for a home visit if prescribed by the attending Contracting Physician. 3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. SAMPLE 4. Prior authorization is not required. 8.1 Covered Hospice Care Services Benefits will be provided for the services listed below when provided by a Qualified Hospice Care Program. Coverage for hospice care services is subject to certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirements. A. Inpatient and outpatient care; B. Intermittent Skilled Nursing Care; C. Medical social services for the terminally ill patient and his or her Immediate Family; D. Counseling, including dietary counseling, for the terminally ill Member;
Appears in 5 contracts
Samples: Individual Enrollment Agreement, Individual Enrollment Agreement, Individual Enrollment Agreement
Additional Home Health Care Benefits. A. Home Visits Following Surgical Removal of a Testicle For a Member who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, benefits will be provided for:
1. One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and
2. An additional home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
B. Home Visits Following a Mastectomy
1. For a Member who has a shorter hospital stay than that provided under Section 5.2.B, Inpatient Coverage Following a Mastectomy, or who undergoes a Mastectomy on an outpatient basis, benefits will be provided for:: SAMPLE
a) One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and SAMPLEand
b) An additional home visit if prescribed by the Member’s attending Contracting Physician.
2. For a Member who remains in the hospital for at least the length of time provided in Section 5.2.B, Inpatient Coverage Following a Mastectomy, coverage will be provided for a home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
C. Postpartum Home Visits Home visits following delivery are covered in accordance with the most current standards published by the American College of Obstetricians and Gynecologists.
1. For a mother and newborn child who have a shorter hospital stay than that provided under Section 5.2.D, Childbirth, benefits will be provided for:
a) One home visit scheduled to occur within 24 hours after hospital discharge; and
b) An additional home visit if prescribed by the attending Contracting Physician.
2. For a mother and newborn child who remain in the hospital for at least the length of time provided under Section 5.2.D, Childbirth, benefits will be provided for a home visit if prescribed by the attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. SAMPLE .
4. Prior authorization is not required.
D. Home Based Care SAMPLE Members with Chronic Conditions. 8.1 Covered Hospice Care Services Benefits For a member who has been identified with a chronic condition with certain risk factors as designated by a CareFirst BlueChoice clinical professional, benefit will be provided for an additional home visit if prescribed by the services listed below when provided by a Qualified Hospice Care Program. Coverage for hospice care services is subject to certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirementsMember’s attending physician.
A. Inpatient and outpatient care;
B. Intermittent Skilled Nursing Care;
C. Medical social services for the terminally ill patient and his or her Immediate Family;
D. Counseling, including dietary counseling, for the terminally ill Member;
Appears in 3 contracts
Samples: Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Additional Home Health Care Benefits. A. Home Visits Following Surgical Removal of a Testicle For a Member who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, benefits will be provided for:
1. One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and
2. An additional home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
B. Home Visits Following a Mastectomy
1. For a Member who has a shorter hospital stay than that provided under Section 5.2.B, Inpatient Coverage Following a Mastectomy, or who undergoes a Mastectomy on an outpatient basis, benefits will be provided for:
a) One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and SAMPLEand
b) An additional home visit if prescribed by the Member’s attending Contracting Physician.
2. For a Member who remains in the hospital for at least the length of time provided in Section 5.2.B, Inpatient Coverage Following a Mastectomy, coverage will be provided for a home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
C. Postpartum Home Visits Home visits following delivery are covered in accordance with the most current standards published by the American College of Obstetricians and Gynecologists.
1. For a mother and newborn child who have a shorter hospital stay than that provided under Section 5.2.D, Childbirth, benefits will be provided for:
a) One home visit scheduled to occur within 24 hours after hospital discharge; and
b) An additional home visit if prescribed by the attending Contracting Physician.
2. For a mother and newborn child who remain in the hospital for at least the length of time provided under Section 5.2.D, Childbirth, benefits will be provided for a home visit if prescribed by the attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. SAMPLE .
4. Prior authorization is not required. 8.1 Covered Hospice Care Services Benefits will be provided for the services listed below when provided by a Qualified Hospice Care Program. Coverage for hospice care services is subject to certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirements.
A. Inpatient and outpatient care;
B. Intermittent Skilled Nursing Care;
C. Medical social services for the terminally ill patient and his or her Immediate Family;
D. Counseling, including dietary counseling, for the terminally ill Member;
Appears in 1 contract
Samples: Individual Enrollment Agreement
Additional Home Health Care Benefits. A. Home Visits Following Surgical Removal of a Testicle For a Member who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, benefits will be provided for:
1. One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and
2. An additional home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
B. Home Visits Following a Mastectomy
1. For a Member who has a shorter hospital stay than that provided under Section 5.2.B, Inpatient Coverage Following a Mastectomy, or who undergoes a Mastectomy on an outpatient basis, benefits will be provided for:: Sample
a) One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and SAMPLEand
b) An additional home visit if prescribed by the Member’s attending Contracting Physician.
2. For a Member who remains in the hospital for at least the length of time provided in Section 5.2.B, Inpatient Coverage Following a Mastectomy, coverage will be provided for a home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
C. Postpartum Home Visits Home visits following delivery are covered in accordance with the most current standards published by the American College of Obstetricians and Gynecologists.
1. For a mother and newborn child who have a shorter hospital stay than that provided under Section 5.2.D, Childbirth, benefits will be provided for:
a) One home visit scheduled to occur within 24 hours after hospital discharge; and
b) An additional home visit if prescribed by the attending Contracting Physician.
2. For a mother and newborn child who remain in the hospital for at least the length of time provided under Section 5.2.D, Childbirth, benefits will be provided for a home visit if prescribed by the attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. SAMPLE Sample
4. Prior authorization is not required. 8.1 Covered Hospice Care Services Benefits will be provided for the services listed below when provided by a Qualified Hospice Care Program. Coverage for hospice care services is subject to certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirements.
A. Inpatient and outpatient care;
B. Intermittent Skilled Nursing Care;
C. Medical social services for the terminally ill patient and his or her Immediate Family;
D. Counseling, including dietary counseling, for the terminally ill Member;
E. Non-Custodial home health visits; Sample
F. Services, visits, medical/surgical equipment, or supplies, including equipment and medication required to maintain the comfort and manage the pain of the terminally ill Member;
G. Laboratory test and x-ray services;
H. Medically Necessary ground ambulance, as determined by CareFirst BlueChoice;
I. Family Counseling will be provided to the Immediate Family and the Family Caregiver before the death of the terminally ill Member, when authorized or approved by CareFirst BlueChoice; and J. Bereavement Counseling.
Appears in 1 contract
Samples: Individual Enrollment Agreement for a Qualified Health Plan
Additional Home Health Care Benefits. A. Home Visits Following Surgical Removal of a Testicle For a Member who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, benefits will be provided for:
1. One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and
2. An additional home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
B. Home Visits Following a MastectomyMastectomy SAMPLE
1. For a Member who has a shorter hospital stay than that provided under Section 5.2.B, Inpatient Coverage Following a Mastectomy, or who undergoes a Mastectomy on an outpatient basis, benefits will be provided for:
a) One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and SAMPLEand
b) An additional home visit if prescribed by the Member’s attending Contracting Physician.
2. For a Member who remains in the hospital for at least the length of time provided in Section 5.2.B, Inpatient Coverage Following a Mastectomy, coverage will be provided for a home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
C. Postpartum Home Visits Home visits following delivery are covered in accordance with the most current standards published by the American College of Obstetricians and Gynecologists.
1. For a mother and newborn child who have a shorter hospital stay than that provided under Section 5.2.D, Childbirth, benefits will be provided for:
a) One home visit scheduled to occur within 24 hours after hospital discharge; and
b) An additional home visit if prescribed by the attending Contracting Physician.
2. For a mother and newborn child who remain in the hospital for at least the length of time provided under Section 5.2.D, Childbirth, benefits will be provided for a home visit if prescribed by the attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. SAMPLE 4. Prior authorization is not required. 8.1 Covered Hospice Care Services Benefits will be provided for the services listed below when provided by a Qualified Hospice Care Program. Coverage for hospice care services is subject to certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirements.
A. Inpatient and outpatient care;
B. Intermittent Skilled Nursing Care;
C. Medical social services for the terminally ill patient and his or her Immediate Family;
D. Counseling, including dietary counseling, for the terminally ill Member;
Appears in 1 contract
Samples: Individual Enrollment Agreement
Additional Home Health Care Benefits. A. Home Visits Following Surgical Removal of a Testicle For a Member who receives less than 48 hours of inpatient hospitalization following the surgical removal of a testicle, or who undergoes the surgical removal of a testicle on an outpatient basis, benefits will be provided for:
1. One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and
2. An additional home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
B. Home Visits Following a MastectomyMastectomy SAMPLE
1. For a Member who has a shorter hospital stay than that provided under Section 5.2.B, Inpatient Coverage Following a Mastectomy, or who undergoes a Mastectomy on an outpatient basis, benefits will be provided for:
a) One home visit scheduled to occur within twenty-four (24) hours after discharge from the hospital or outpatient health care facility; and SAMPLEand
b) An additional home visit if prescribed by the Member’s attending Contracting Physician.
2. For a Member who remains in the hospital for at least the length of time provided in Section 5.2.B, Inpatient Coverage Following a Mastectomy, coverage will be provided for a home visit if prescribed by the Member’s attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum.
4. Prior authorization is not required.
C. Postpartum Home Visits Home visits following delivery are covered in accordance with the most current standards published by the American College of Obstetricians and Gynecologists.
1. For a mother and newborn child who have a shorter hospital stay than that provided under Section 5.2.D, Childbirth, benefits will be provided for:
a) One home visit scheduled to occur within 24 hours after hospital discharge; and
b) An additional home visit if prescribed by the attending Contracting Physician.
2. For a mother and newborn child who remain in the hospital for at least the length of time provided under Section 5.2.D, Childbirth, benefits will be provided for a home visit if prescribed by the attending Contracting Physician.
3. Benefits provided under this provision do not count toward any Home Health Care visit maximum. SAMPLE 4. Prior authorization is not required. 8.1 Covered Hospice Care Services Benefits will be provided for the services listed below when provided by a Qualified Hospice Care Program. Coverage for hospice care services is subject to certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirements.
A. Inpatient and outpatient care;
B. Intermittent Skilled Nursing Care;
C. Medical social services for the terminally ill patient and his or her Immediate Family;
D. Counseling, including dietary counseling, for the terminally ill Member;; SAMPLE
Appears in 1 contract
Samples: Individual Enrollment Agreement for a Qualified Health Plan
