Conditions for Coverage. Skilled Nursing Facility care must be authorized or approved by CareFirst BlueChoice as meeting the following conditions for coverage: A. The Member must be under the care of his or her primary care physician or other Contracting Provider. B. The admission to the Skilled Nursing Facility must be a substitute for hospital care (i.e., if the Member were not admitted to a Skilled Nursing Facility, he or she would have to be admitted to a hospital). C. Skilled Nursing Facility benefits will not be provided in a facility that is used primarily as a rest home or a home for the aged, or in a facility for the care of drug addiction or alcoholism. D. The Member must require Skilled Nursing Care or skilled rehabilitation services which are: 1. Required on a daily basis; 2. Not Custodial; and, 3. Only provided on an inpatient basis.
Appears in 2 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Conditions for Coverage. Skilled Nursing Facility care must be authorized or approved by CareFirst BlueChoice as meeting the following conditions for coverage:
A. The Member must be under the care of his or her primary care physician Primary Care Physician or other Contracting ProviderPhysician.
B. The admission to the Skilled Nursing Facility must be a substitute for hospital care (i.e., if the Member were not admitted to a Skilled Nursing Facility, he or she would have to be admitted to a hospital).
C. Skilled Nursing Facility benefits will not be provided in a facility that is used primarily as a rest home or a home for the aged, or in a facility for the care of drug addiction or alcoholism.
D. The Member must require Skilled Nursing Care or skilled rehabilitation services which are:
1. Required on a daily basis;
2. Not Custodial; and,
3. Only provided on an inpatient basis.
Appears in 2 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement
