Custodial Care is Not Provided. Benefits will not be provided for any day in a Skilled Nursing Facility that CareFirst determines is primarily for Custodial Care. Services may be deemed Custodial Care even if: A. A Member cannot self-administer the care; B. No one in the Member’s household can perform the services; C. Ordered by a physician; X. Xxxxxxxxx to maintain the Member’s present condition; or E. Covered by Medicare.
Appears in 6 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Custodial Care is Not Provided. Benefits will not be provided for any day in a Skilled Nursing Facility that CareFirst determines is primarily for Custodial Care. Services may be deemed Custodial Care even if:
A. A Member cannot self-administer the care;
B. No one in the Member’s household can perform the services;
C. Ordered by a physician;
X. Xxxxxxxxx D. Necessary to maintain the Member’s present condition; or E. Covered by Medicare.
Appears in 3 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement
Custodial Care is Not Provided. Benefits will not be provided for any day in a Skilled Nursing Facility that CareFirst determines is primarily for Custodial Care. Services may be deemed Custodial Care even if:
A. A Member cannot self-administer the care;
B. No one in the Member’s 's household can perform the services;
C. Ordered by a physician;
X. Xxxxxxxxx D. Necessary to maintain the Member’s 's present condition; or E. Covered by Medicare.
Appears in 1 contract
Samples: Student Health Plan Individual Enrollment Agreement
Custodial Care is Not Provided. Benefits will not be provided for any day in a Skilled Nursing Facility that CareFirst determines is primarily for Custodial Care. Services may be deemed Custodial Care even if:
A. A Member cannot self-administer the care;
B. No one in the Member’s 's household can perform the services;
C. Ordered by a physician;
X. Xxxxxxxxx to maintain the Member’s present condition; or E. Covered by Medicare.
Appears in 1 contract
Samples: Student Health Plan Individual Enrollment Agreement
