Common use of Habilitative Services Clause in Contracts

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goals. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Medical records. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress we may request additional medical records. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics and prosthetic devices, when used as a part of habilitative services, are described under

Habilitative Services. SAMPLE For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goals. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Medical records. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress we may request additional medical records. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics orthotics and prosthetic devices, when used as a part of habilitative services, are described underunder Durable Medical Equipment (DME), Orthotics and Prosthetic Devices.

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goals. goals i. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Medical records. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress we may request additional medical records. SAMPLE Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics and prosthetic devices, when used as a part of habilitative services, are described underunder Durable Medical Equipment (DME), Orthotics and Prosthetic Devices.

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goals. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Medical records. • Other necessary data to allow us to prove that medical treatment is needed. SAMPLE When the treating provider expects that continued treatment is or will be required to allow you to achieve progress we may request additional medical records. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics orthotics and prosthetic devices, when used as a part of habilitative services, are described underunder Durable Medical Equipment (DME), Orthotics and Prosthetic Devices. Services received from a Home Health Agency that are all of the following: • Ordered by a Physician. • Provided in your home by a registered nurse, or provided by a home health aide, home health therapist, or licensed practical nurse and supervised by a registered nurse. • Provided on a part-time, Intermittent Care schedule. • Provided when Skilled Care is required. • Provides each patient with a planned program of observation and treatment by a Physician, in accordance with existing standards of medical practice for the Sickness or Injury requiring the Home Health Care. We will determine if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management.

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: SAMPLE • Physical therapy. • Occupational therapy. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goals. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Medical records. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress we may request additional medical records. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics and prosthetic devices, when used as a part of habilitative services, are described under

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. SAMPLE • Educational/vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goals. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Medical records. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress we may request additional medical records. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics and prosthetic devices, when used as a part of habilitative services, are described underunder Durable Medical Equipment (DME), Orthotics and Prosthetic Devices.

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Manipulative Treatment. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪ Licensed speech-language pathologist. ▪ Licensed audiologist. ▪ Licensed occupational therapist. ▪ Licensed physical therapist. SAMPLE ▪ Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational Vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goalsgoals in a treatment plan within a prescribed time frame. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Treatment plan. • Medical records. • Clinical notes. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress that is capable of being demonstrated, we may request additional medical recordsa treatment plan that includes: • Diagnosis. • Proposed treatment by type, frequency, and expected duration of treatment. • Expected treatment goals. • Frequency of treatment plan updates. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Habilitative services provided in your home other than by a Home Health Agency are provided as described under this section. Benefits for DME, Orthotics DME and prosthetic devices, when used as a part of habilitative services, are described underunder Durable Medical Equipment (DME), Orthotics and Supplies and Prosthetic Devices.

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Manipulative Treatment. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪  Licensed speech-language pathologist. ▪  Licensed audiologist. ▪  Licensed occupational therapist. ▪  Licensed physical therapist. ▪  Physician. • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational Vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goalsgoals in a treatment plan within a prescribed time frame. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Treatment plan. • Medical records. • Clinical notes. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress that is capable of being demonstrated, we may request additional medical recordsa treatment plan that includes: • Diagnosis. • Proposed treatment by type, frequency, and expected duration of treatment. • Expected treatment goals. • Frequency of treatment plan updates. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Benefits for DME, Orthotics and prosthetic devices, when used Habilitative services provided in your home other than by a Home Health Agency are provided as a part of habilitative services, are described underunder this section.

Habilitative Services. For purposes of this Benefit, "habilitative services" means Skilled Care services that are part of a prescribed treatment plan or maintenance program to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. We will decide if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Therapies provided for the purpose of general well-being or conditioning in the absence of a disabling condition are not considered habilitative services. Habilitative services are limited to: • Physical therapy. • Occupational therapy. • Manipulative Treatment. • Speech therapy. • Post-cochlear implant aural therapy. SAMPLE • Cognitive therapy. Benefits are provided for habilitative services for both inpatient services and outpatient therapy when you have a disabling condition when both of the following conditions are met: • Treatment is administered by any of the following: ▪  Licensed speech-language pathologist. ▪  Licensed audiologist. ▪  Licensed occupational therapist. ▪  Licensed physical therapist. ▪  Physician. Sample • Treatment must be proven and not Experimental or Investigational. The following are not habilitative services: • Custodial Care. • Respite care. • Day care. • Therapeutic recreation. • Educational/vocational Vocational training. • Residential Treatment. • A service or treatment plan that does not help you meet functional goalsgoals in a treatment plan within a prescribed time frame. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. We may require the following be provided: • Treatment plan. • Medical records. • Clinical notes. • Other necessary data to allow us to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress that is capable of being demonstrated, we may request additional medical recordsa treatment plan that includes: • Diagnosis. • Proposed treatment by type, frequency, and expected duration of treatment. • Expected treatment goals. • Frequency of treatment plan updates. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Habilitative services provided in your home other than by a Home Health Agency are provided as described under this section. Benefits for DME, Orthotics DME and prosthetic devices, when used as a part of habilitative services, are described underunder Durable Medical Equipment (DME), Orthotics and Supplies and Prosthetic Devices.