Conditions for Coverage. Hospice care services must be certified by CareFirst, provided by a Qualified Hospice Care Program, and meet the following conditions for coverage: A. The Member must have a life expectancy of six (6) months or less; B. The Member’s attending physician must submit a written hospice care services plan of treatment to CareFirst; C. The Member must meet the criteria of the Qualified Hospice Care Program; D. The need and continued appropriateness of hospice care services must be certified by CareFirst as meeting the criteria for coverage in accordance with CareFirst utilization management requirements.
Appears in 9 contracts
Sources: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Conditions for Coverage. Hospice care services must be certified by CareFirst, provided by a Qualified Hospice Care Program, and meet the following conditions for coverage:
A. The Member must have a life expectancy of six (6) months or less;
B. The Member’s 's attending physician must submit a written hospice care services plan Plan of treatment Treatment to CareFirst;
C. The Member must meet the criteria of the Qualified Hospice Care Program;
D. The need and continued appropriateness of hospice care services must be certified by CareFirst as meeting the criteria for coverage in accordance with CareFirst utilization management requirements.
Appears in 2 contracts
Sources: Member Contract, Member Contract
Conditions for Coverage. Hospice care services must be certified by CareFirst, provided by a Qualified Hospice Care Program, and meet the following conditions for coverage:
A. The Member must have a life expectancy of six (6) months or less;
B. The Member’s 's attending physician must submit a written hospice care services plan Plan of treatment Treatment to CareFirst;
C. The Member must meet the criteria of the Qualified Hospice Care Program;
D. Prior authorization has been obtained from CareFirst.
E. The need and continued appropriateness of hospice care services must be certified by CareFirst as meeting the criteria for coverage in accordance with CareFirst utilization management requirements.
Appears in 1 contract
Sources: Student Health Plan Individual Enrollment Agreement