Common use of Chemotherapy Clause in Contracts

Chemotherapy. Eligible health services for chemotherapy depend on where treatment is received. In most cases, chemotherapy is covered as outpatient care. However, your hospital benefit covers the initial dose of chemotherapy after a cancer diagnosis during a hospital stay. • A free-standing outpatient facility • The outpatient department of a hospital • A physician in his/her office • A home care provider in your home You can access the list of preferred infusion locations by contacting Member Services by logging onto your secure member website at xxx.xxxxx.xxx or calling the number on the back of your ID card. Infusion therapy is the parenteral (i.e. intravenous) administration of prescribed medications or solutions. Certain infused medications may be covered under the outpatient prescription drug rider. You can access the list of specialty prescription drugs by contacting Member Services or by logging onto your secure member website at xxx.xxxxx.xxx or calling the number on the back of your ID card to determine if coverage is under the outpatient prescription drug rider or this EOC. When Infusion therapy services and supplies are provided in your home, they will not count toward any applicable home health care maximums. Eligible health services include the following radiology services provided by a health professional: • Radiological services • Gamma ray • Accelerated particles • Mesons • Neutrons • Radium • Radioactive isotopes Eligible health services include cardiac rehabilitation services you receive at a hospital, skilled nursing facility or physician’s office, but only if those services are part of a treatment plan determined by your risk level and ordered by your physician. Eligible health services include pulmonary rehabilitation services as part your inpatient hospital stay if it is part of a treatment plan ordered by your physician. A course of outpatient pulmonary rehabilitation may also be eligible for coverage if it is performed at a hospital, skilled nursing facility, or physician’s office, is used to treat reversible pulmonary disease states, and is part of a treatment plan ordered by your physician. Short-term rehabilitation services help you restore or develop skills and functioning for daily living. Eligible health services include short-term rehabilitation services your physician prescribes. The services have to be performed by: • A licensed or certified physical, occupational or speech therapist • A hospital, skilled nursing facility, or hospice facility • A home health care agency • A physician Short-term rehabilitation services have to follow a specific treatment plan, ordered by your physician. • Physical therapy, but only if it is expected to significantly improve or restore physical functions lost as a result of an acute illness, injury or surgical procedure. • Occupational therapy (except for vocational rehabilitation or employment counseling), but only if it is expected to: - Significantly improve, develop or restore physical functions you lost as a result of an acute illness, injury or surgical procedure, or - Relearn skills so you can significantly improve your ability to perform activities of daily living on your own. - Speech therapy without regard to whether there is a physical cause. Speech function is the ability to express thoughts, speak words and form sentences. Speech impairment is difficulty with expressing one’s thoughts with spoken words. • Cognitive rehabilitation associated with physical rehabilitation, but only when: - Your cognitive deficits are caused by neurologic impairment due to trauma, stroke, or encephalopathy and - The therapy is coordinated with us as part of a treatment plan intended to restore previous cognitive function. Your provider must establish or approve a treatment plan that details the treatment, and specifies frequency and duration. Habilitation therapy services are services that help you keep, learn, or improve skills and functioning for daily living (e.g. therapy for a child who isn’t walking or talking at the expected age) Eligible health services include habilitation therapy services your physician prescribes. The services have to be performed by: • A licensed or certified physical, occupational or speech therapist • A hospital, skilled nursing facility, or hospice facility • A home health care agency • A physician Habilitation therapy services have to follow a specific treatment plan, ordered by your physician. • Physical therapy, if it is expected to develop any impaired function • Occupational therapy (except for vocational rehabilitation or employment counseling), if it is expected to: - Develop any impaired function, or - Relearn skills so you can significantly develop your ability to perform activities of daily living on your own. • Speech therapy is covered without regard to whether there is a physical cause.

Chemotherapy. Eligible health services for chemotherapy depend on where treatment is received. In most cases, chemotherapy is covered as outpatient care. However, your hospital benefit covers the initial dose of chemotherapy after a cancer diagnosis during a hospital stay. •  A free-standing outpatient facility •  The outpatient department of a hospital •  A physician in his/her office •  A home care provider in your home You can access the list of preferred infusion locations by contacting Member Services by logging onto your Aetna Navigator® secure member website at xxx.xxxxx.xxx or calling the number on the back of your ID card. Infusion therapy is the parenteral (i.e. intravenous) administration of prescribed medications or solutions. Certain infused medications may be covered under the outpatient prescription drug rider. You can access the list of specialty prescription drugs by contacting Member Services or by logging onto your Aetna Navigator® secure member website at xxx.xxxxx.xxx or calling the number on the back of your ID card to determine if coverage is under the outpatient prescription drug rider or this EOC. When Infusion therapy services and supplies are provided in your home, they will not count toward any applicable home health care maximums. Eligible health services include the following radiology services provided by a health professional: •  Radiological services •  Gamma ray •  Accelerated particles •  Mesons •  Neutrons •  Radium •  Radioactive isotopes Eligible health services include cardiac rehabilitation services you receive at a hospital, skilled nursing facility or physician’s office, but only if those services are part of a treatment plan determined by your risk level and ordered by your physician. Eligible health services include pulmonary rehabilitation services as part your inpatient hospital stay if it is part of a treatment plan ordered by your physician. A course of outpatient pulmonary rehabilitation may also be eligible for coverage if it is performed at a hospital, skilled nursing facility, or physician’s office, is used to treat reversible pulmonary disease states, and is part of a treatment plan ordered by your physician. Short-term rehabilitation services help you restore or develop skills and functioning for daily living. Eligible health services include short-term rehabilitation services your physician prescribes. The services have to be performed by: •  A licensed or certified physical, occupational or speech therapist •  A hospital, skilled nursing facility, or hospice facility •  A home health care agency •  A physician Short-term rehabilitation services have to follow a specific treatment plan, ordered by your physician. •  Physical therapy, but only if it is expected to significantly improve or restore physical functions lost as a result of an acute illness, injury or surgical procedure. •  Occupational therapy (except for vocational rehabilitation or employment counseling), but only if it is expected to: - Significantly improve, develop or restore physical functions you lost as a result of an acute illness, injury or surgical procedure, or - Relearn skills so you can significantly improve your ability to perform activities of daily living on your own. - Speech therapy without regard to whether there is a physical cause. Speech function is the ability to express thoughts, speak words and form sentences. Speech impairment is difficulty with expressing one’s thoughts with spoken words. •  Cognitive rehabilitation associated with physical rehabilitation, but only when: - Your cognitive deficits are caused by neurologic impairment due to trauma, stroke, or encephalopathy and - The therapy is coordinated with us as part of a treatment plan intended to restore previous cognitive function. Eligible health services include spinal manipulation to correct a muscular or skeletal problem. Your provider must establish or approve a treatment plan that details the treatment, and specifies frequency and duration. Habilitation therapy services are services that help you keep, learn, or improve skills and functioning for daily living (e.g. therapy for a child who isn’t walking or talking at the expected age) Eligible health services include habilitation therapy services your physician prescribes. The services have to be performed by: •  A licensed or certified physical, occupational or speech therapist •  A hospital, skilled nursing facility, or hospice facility •  A home health care agency •  A physician Habilitation therapy services have to follow a specific treatment plan, ordered by your physician. •  Physical therapy, if it is expected to develop any impaired function •  Occupational therapy (except for vocational rehabilitation or employment counseling), if it is expected to: - Develop any impaired function, or - Relearn skills so you can significantly develop your ability to perform activities of daily living on your own. •  Speech therapy is covered without regard to whether there is a physical cause.

Chemotherapy. Eligible health services for chemotherapy depend on where treatment is received. In most cases, chemotherapy is covered as outpatient care. However, your hospital benefit covers the initial dose of chemotherapy after a cancer diagnosis during a hospital stay. • A free-standing outpatient facility • The outpatient department of a hospital • A physician in his/her office • A home care provider in your home You See the How to contact us for help section to learn how you can access the list of preferred infusion locations by contacting Member Services by logging onto your secure member website at xxx.xxxxx.xxx or calling the number on the back of your ID cardlocations. Infusion therapy is the parenteral (i.e. intravenous) administration of prescribed medications or solutionssolutions through an IV. Certain infused medications may be covered under the outpatient prescription drug ridersection. You can access the list of specialty prescription drugs by contacting Member Services or by logging onto your secure member website at xxx.xxxxx.xxx or calling drugs. See the number on the back of your ID card How to contact us for help section to determine if coverage is under the outpatient prescription drug rider section or this EOCsection. When Infusion infusion therapy services and supplies are provided in your home, they will not count toward any applicable home health care maximumslimits. Eligible health services include the following radiology services provided by a health professional: • Radiological services • Gamma ray • Accelerated particles • Mesons • Neutrons • Radium • Radioactive isotopes Eligible health services include specialty prescription drugs when they are: • Purchased by your provider • Injected or infused by your provider in an outpatient setting such as: - A free-standing outpatient facility - The outpatient department of a hospital - A physician in his/her office - A home care provider in your home • Listed on our specialty prescription drug list as covered under this policy. You can access the list of specialty prescription drugs. See the How to contact us for help section to determine if coverage is under the outpatient prescription drug section or this section. Certain infused medications may be covered under the outpatient prescription drug section. You can access the list of specialty prescription drugs. See the How to contact us for help section to determine if coverage is under the outpatient prescription drug section or this section. When injectable or infused services and supplies are provided in your home, they will not count toward any applicable home health care limits. Eligible health services include cardiac rehabilitation services you receive at a hospital, skilled nursing facility or physician’s office, but only if those services are part of a treatment plan determined by your risk level and ordered by your physician. Eligible health services include pulmonary rehabilitation services as part your inpatient hospital stay if it is part of a treatment plan ordered by your physician. A course of outpatient pulmonary rehabilitation may also be eligible for coverage if it is it’s performed at a hospital, skilled nursing facility, or physician’s office, is used to treat reversible pulmonary disease states, and is part of a treatment plan ordered by your physician. Short-term rehabilitation services help you restore or develop skills and functioning for daily living. Eligible health services include short-term rehabilitation services your physician prescribes. The services have to be performed byby a: • A licensed Licensed or certified physical, occupational or speech therapist • A hospitalHospital, skilled nursing facility, or hospice facility • A home Home health care agency • A physician Physician Short-term rehabilitation services have to follow a specific treatment plan, ordered by your physician. • Physical therapy, but only if it is expected to significantly improve or restore physical functions lost as a result of an acute illness, injury or surgical procedure. • Occupational therapy (except for vocational rehabilitation or employment counseling), but only if it is expected to: - Significantly improve, develop or restore physical functions you lost as a result of an acute illness, injury or surgical procedure, or . - Relearn skills so you can significantly improve regain your ability to perform the activities of daily living on your own. • Speech therapy, but only if it is expected to: - Speech therapy without regard to whether there is Significantly improve or restore the speech function or correct a physical causespeech impairment as a result of an acute illness, injury or surgical procedure. - Improve delays in speech function development caused by a gross anatomical defect present at birth. Speech function is the ability to express thoughts, speak words and form sentences. Speech impairment is difficulty with expressing one’s thoughts with spoken words. • Cognitive rehabilitation associated with physical rehabilitation, but only when: - Your cognitive deficits are caused by neurologic impairment due to trauma, stroke, or encephalopathy and encephalopathy. - The therapy is coordinated with us as part of a treatment plan intended to restore previous cognitive function. Your provider must establish or approve a treatment plan that details the treatment, and specifies frequency and duration. Habilitation therapy services are services that help you keep, learn, or improve skills and functioning for daily living (e.g. therapy for a child who isn’t walking or talking at the expected age) ). Eligible health services include habilitation therapy services your physician prescribes. The services have to be performed byprovided by a: • A licensed Licensed or certified physical, occupational or speech therapist • A hospitalHospital, skilled nursing facility, or hospice facility • A home Home health care agency • A physician Physician Habilitation therapy services have to follow a specific treatment plan, ordered by your physician. • Physical therapy, if it is expected to develop any impaired function • Occupational therapy (except for vocational rehabilitation or employment counseling), if it is expected to: - Develop any impaired function, or function - Relearn skills so you can significantly develop your ability to perform the activities of daily living on your own. own • Speech therapy is covered without regard provided the therapy is expected to: - Develop speech function as a result of delayed development Speech function is the ability to whether there is a physical causeexpress thoughts, speak words and form sentences.