Common use of Home Health Care Services Clause in Contracts

Home Health Care Services. Home Health Care provides a program for a Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage. A visit consists of up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical, Occupational, or Speech Therapy sections shown in this Contract. Some special conditions apply: • The Physician’s certification statement and plan of care. • Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. • A Member must be essentially confined at home. Covered Services: • Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. • Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. • Visits by a Home Health Care Nursing Aide when rendered under the direct supervision of an RN. • Administration of prescribed drugs. • Oxygen and its administration. • Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. • Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. • Any services for any period during which the Member is not under the continuing care of a Physician. • Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. • Any services or supplies not specifically listed as Covered Services. • Routine care of a newborn child. • Dietitian services. • Maintenance therapy. • Private duty nursing care. Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill. Your Contract provides Covered Services for inpatient and outpatient Hospice care under certain conditions as stated in the

Home Health Care Services. Home Health Care provides a program for a Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage. A visit consists of up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical, Occupational, or Speech Therapy sections shown in this Contract. Some special conditions apply: • The Covered Services require the Physician’s certification statement and plan of care. • Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. • A Member must be essentially confined at home. Covered Services: • Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. • Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. • Visits by a Home Health Care Nursing Aide when rendered under the direct supervision of an RNanRN. • Administration of prescribed drugs. • Oxygen and its administration. administration • Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. • Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. • Any services for any period during which the Member is not under the continuing care of a Physician. • Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. • Any services or supplies not specifically listed as Covered Services. • Routine care of a newborn child. • Dietitian services. • Maintenance therapy. • Private duty nursing care. Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill. Your Contract provides Covered Services for inpatient and outpatient Hospice care under certain conditions as stated in the

Home Health Care Services. Home Health Care provides a program for a Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage. A visit consists of up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical, Occupational, or Speech Therapy sections shown in this Contract. Some special conditions apply: • The Covered Services require the Physician’s certification statement and plan of care. • Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. • A Member must be essentially confined at home. Covered Services: • Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. • Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. • Visits by a Home Health Care Nursing Aide when rendered under the direct supervision of an RN. • Administration of prescribed drugs. • Oxygen and its administration. administration • Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. • Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. • Any services for any period during which the Member is not under the continuing care of a Physician. • Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. • Any services or supplies not specifically listed as Covered Services. • Routine care of a newborn child. • Dietitian services. • Maintenance therapy. • Private duty nursing care. Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill. Your Contract provides Covered Services for inpatient and outpatient Hospice care under certain conditions as stated in the

Home Health Care Services. Home Health Care provides a program for a Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage. A visit consists of up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. These services have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical, Occupational, or Speech Therapy sections shown in this Contract. Some special conditions apply: • The Physician’s certification statement and plan of care. • Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. • A Member must be essentially confined at home. Covered Services: • Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. • Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. • Visits by a Home Health Care Nursing Aide when rendered under the direct supervision of an RNanRN. • Administration of prescribed drugs. • Oxygen and its administration. • Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. • Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. • Any services for any period during which the Member is not under the continuing care of a Physician. • Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. • Any services or supplies not specifically listed as Covered Services. • Routine care of a newborn child. • Dietitian services. • Maintenance therapy. • Private duty nursing care. Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill. Your Contract provides Covered Services for inpatient and outpatient Hospice care under certain conditions as stated in the

Home Health Care Services. Home Health Care provides a program for a Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage. A visit consists of up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. These services require Prior Authorization and have calendar year visit limits. Plan limits are outlined in the Summary of Benefits and Coverage. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical, Occupational, or Speech Therapy sections shown in this Contract. Some special conditions apply: • The Physician’s certification statement and plan of carerecommended program must obtain a Prior Authorization. • Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. • A Member must be essentially confined at home. Covered Services: • Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. • Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. • Visits by a Home Health Care Nursing Aide when rendered under the direct supervision of an RN. • Administration of prescribed drugs. • Oxygen and its administration. • Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. • Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. • Any services for any period during which the Member is not under the continuing care of a Physician. • Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. • Any services or supplies not specifically listed as Covered Services. • Routine care of a newborn child. • Dietitian services. • Maintenance therapy. • Private duty nursing care. Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill. Your Contract provides Covered Services for inpatient and outpatient Hospice care under certain conditions as stated in the • Be recognized as an approved Hospice program by Alliant; • Include support services to help covered family members deal with the patient’s death; and • Be directed by a Physician and coordinated by an RN with a treatment plan that: o Provides an organized system of home care; o Uses a Hospice team; and o Has around-the-clock care available. The following conditions apply: • To qualify for Hospice care, the attending Physician must certify that the patient is not expected to live more than six months; • The Physician must design and recommend a Hospice Care Program; and • The Physician’s statement and recommended program should obtain a Prior Authorization.