Common use of Infertility Benefits Clause in Contracts

Infertility Benefits. Benefits are provided for the diagnosis and treatment of the cause of Infertility, including professional, Hospital, Ambulatory Surgery Center, and related services to diagnose and treat the cause of Infertility, with the exception of what is excluded in the Exclusions and limitations section. Fertility preservation services are covered for Members undergoing treatment or receiving Covered Services that may directly or indirectly cause iatrogenic Infertility. Under these circumstances, standard fertility preservation services are a Covered Service and do not fall under the scope of Infertility Benefits described in the Family Planning and Infertility Benefits section. Benefits are available for home health services. These services include home health agency services, home infusion and injectable medication services, and hemophilia home infusion services. Benefits are available from a Participating home health care agency for diagnostic and treatment services received in your home under a written treatment plan approved by your Physician. Benefits include: • Intermittent home care for skilled services from: o Registered nurses; o Licensed vocational nurses; o Physical therapists; o Occupational therapists; o Speech and language pathologists; o Licensed clinical social workers; and o Home Health Aides. • Related medical supplies. Intermittent home care is for skilled services you receive: • Fewer than seven days per week; or • Daily, for fewer than eight hours per day, up to 21 days. Benefits are limited to a visit maximum as shown in the Summary of Benefits section for home health agency visits. For this Benefit, coverage includes: • Up to four visits per day, two hours maximum per visit, with a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech and language pathologist, or licensed clinical social worker. A visit of two hours or less is considered one visit. Nursing visits cannot be combined to provide Continuous Nursing Services. • Up to four hours maximum per visit with a Home Health Aide. A visit of four hours or less is considered one visit. Benefits do not include: • Continuous Nursing Services provided by a registered nurse or a licensed vocational nurse, on a one-to-one basis, in an inpatient or home setting. These services may also be described as “shift care” or “private-duty nursing.” Benefits are available through a Participating home infusion agency for home infusion, enteral, and injectable medication therapy. Benefits include: • Home infusion agency Skilled Nursing visits; • Infusion therapy provided in an infusion suite associated with a Participating home infusion agency; • Parenteral nutrition services and associated supplies and solutions; • Enteral nutrition services and associated supplies and solutions; • Medical supplies used during a covered visit; and • Medications injected or administered intravenously. There is no Calendar Year visit maximum for home infusion agency services. This Benefit does not include: • Insulin; • Insulin syringes; and • Services related to hemophilia, which are described below. Benefits are available for hemophilia home infusion products and services for the treatment of hemophilia and other bleeding disorders. Benefits must be prior authorized and provided in the home or in an infusion suite managed by a Participating Hemophilia Home Infusion Provider. Benefits include: • 24-hour service; • Home delivery of hemophilia infusion products; • Blood factor product; • Supplies for the administration of blood factor product; and • Nursing visits for training or administration of blood factor products. There is no Calendar Year visit maximum for hemophilia home infusion agency services. Benefits do not include: • In-home services to treat complications of hemophilia replacement therapy; or • Self-infusion training programs, other than nursing visits to assist in administration of the product. Most Participating home health care and home infusion agencies are not Participating Hemophilia Home Infusion Providers. A list of Participating Hemophilia Home Infusion Providers is available at xxxxxxxxxxxx.xxx. Benefits are available through a Participating Hospice Agency for specialized care if you have been diagnosed with a terminal illness with a life expectancy of one year or less. When you enroll in a Hospice program, you agree to receive all care for your terminal illness through the Hospice Agency. Hospice program enrollment is prior authorized for a specified period of care based on your Physician’s certification of eligibility. The period of care begins the first day you receive Hospice services and ends when the specified timeframe is over or you choose to receive care for your terminal illness outside of the Hospice program. The authorized period of care is for two 90-day periods followed by unlimited 60-day periods, depending on your diagnosis. Your Hospice care continues through to the next period of care when your Physician recertifies that you have a terminal illness. The Hospice Agency works with your Physican to ensure that your Hospice enrollment continues without interruption. You can change your Participating Hospice Agency only once during each period of care. A Hospice program provides interdisciplinary care designed to ease your physical, emotional, social, and spiritual discomfort during the last phases of life, and support your primary caregiver and your family. Hospice services are available 24 hours a day through the Hospice Agency. While enrolled in a Hospice program, you may continue to receive Covered Services that are not related to the care and management of your terminal illness from the appropriate Health Care Provider. However, all care related to your terminal illness must be provided through the Hospice Agency. You may discontinue your Hospice enrollment when an acute Hospital admission is necessary, or at any other time. You may also enroll in the Hospice program again when you are discharged from the Hospital, or at any other time, with Physician recertification. Benefits include: • Pre-Hospice consultation to discuss care options and symptom management; • Advance care planning; • Skilled Nursing Services; • Medical direction and a written treatment plan approved by a Physician; • Continuous Nursing Services provided by registered or licensed vocational nurses, eight to 24 hours per day; • Home Health Aide services, supervised by a nurse; • Homemaker services, supervised by a nurse, to help you maintain a safe and healthy home environment; • Medical social services; • Dietary counseling; • Volunteer services by a Hospice agency; • Short-term inpatient, Hospice house, or Hospice care, if required; • Drugs, medical equipment, and supplies; • Physical therapy, occupational therapy, and speech-language pathology services to control your symptoms or help your ability to perform Activities of Daily Living; • Respiratory therapy; • Occasional, short-term inpatient respite care when necessary to relieve your primary caregiver or family members, up to five days at a time; • Bereavement services for your family; and • Social services, counseling, and spiritual services for you and your family. Benefits do not include: • Services provided by a Non-Participating Hospice Agency, except in certain circumstances where there are no Participating Hospice Agencies in your area and services are prior authorized. Benefits are available for inpatient care in a Hospital. Benefits include: • Room and board, such as: o Semiprivate Hospital room, or private room if Medically Necessary; o Specialized care units, including adult intensive care, coronary care, pediatric and neonatal intensive care, and subacute care;

Infertility Benefits. Benefits are provided for the diagnosis and treatment of the cause of Infertility, including professional, Hospital, Ambulatory Surgery Center, and related ancillary services to diagnose and treat the cause of Infertility, with the exception of what is excluded in the Exclusions and limitations section. Fertility preservation services are covered for Members undergoing treatment or receiving Covered Services that may directly or indirectly cause iatrogenic Infertility. Under these circumstances, standard fertility preservation services are a Covered Service and do not fall under the scope of Infertility Benefits described in the Family Planning and Infertility Benefits section. Benefits are available for home health services. These services include home health agency services, home infusion and injectable medication services, and hemophilia home infusion services. Benefits are available from a Participating home health care agency for diagnostic and treatment services received in your home under a written treatment plan approved by your Physician. Benefits include: •  Intermittent home care for skilled services from: o Registered nurses; o Licensed vocational nurses; o Physical therapists; o Occupational therapists; o Speech and language pathologists; o Licensed clinical social workers; and o Home Health Aides. •  Related medical supplies. Intermittent home care is for skilled services you receive: •  Fewer than seven days per week; or •  Daily, for fewer than eight hours per day, up to 21 days. Benefits are limited to a visit maximum as shown in the Summary of Benefits section for home health agency visits. For this Benefit, coverage includes: •  Up to four three visits per day, two hours maximum per visit, with a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech and language pathologist, or licensed clinical social worker. A visit of two hours or less is considered one visit. Nursing visits cannot be combined to provide Continuous Nursing Services. •  Up to four hours maximum per visit with a Home Health Aide. A visit of four hours or less is considered one visit. Benefits do not include: •  Continuous Nursing Services provided by a registered nurse or a licensed vocational nurse, on a one-to-one basis, in an inpatient or home setting. These services may also be described as “shift care” or “private-private duty nursing.” Benefits are available through a Participating home infusion agency for home infusion, enteral, and injectable medication therapy. Benefits include: •  Home infusion agency Skilled Nursing visits; •  Infusion therapy provided in an infusion suite associated with a Participating home infusion agency; •  Parenteral nutrition services and associated supplies and solutions; •  Enteral nutrition services and associated supplies and solutions; •  Medical supplies used during a covered visit; and •  Medications injected or administered intravenously. There is no Calendar Year visit maximum for home infusion agency services. This Benefit does not include: •  Insulin; •  Insulin syringes; and •  Services related to hemophilia, which are described below. Benefits are available for hemophilia home infusion products and services for the treatment of hemophilia and other bleeding disorders. Benefits must be prior authorized and provided in the home or in an infusion suite managed by a Participating Hemophilia Home Infusion Provider. Benefits include: •  24-hour service; •  Home delivery of hemophilia infusion products; •  Blood factor product; •  Supplies for the administration of blood factor product; and •  Nursing visits for training or administration of blood factor products. There is no Calendar Year visit maximum for hemophilia home infusion agency services. Benefits do not include: •  In-home services to treat complications of hemophilia replacement therapy; or •  Self-infusion training programs, other than nursing visits to assist in administration of the product. Most Participating home health care and home infusion agencies are not Participating Hemophilia Home Infusion Providers. A list of Participating Hemophilia Home Infusion Providers is available at xxxxxxxxxxxx.xxx. Benefits are available through a Participating Hospice Agency for specialized care if you have been diagnosed with a terminal illness with a life expectancy of one year or less. When you enroll in a Hospice program, you agree to receive all care for your terminal illness through the Hospice Agency. Hospice program enrollment is prior authorized for a specified period of care based on your Physician’s certification of eligibility. The period of care begins the first day you receive Hospice services and ends when the specified timeframe is over or you choose to receive care for your terminal illness outside of the Hospice program. The authorized period of care is for two 90-day periods followed by unlimited 60-day periods, depending on your diagnosis. Your Hospice care continues through to the next period of care when your Physician recertifies that you have a terminal illness. The Hospice Agency works with your Physican Physician to ensure that your Hospice enrollment continues without interruption. You can change your Participating Hospice Agency only once during each period of care. A Hospice program provides interdisciplinary care designed to ease your physical, emotional, social, and spiritual discomfort during the last phases of life, and support your primary caregiver and your family. Hospice services are available 24 hours a day through the Hospice Agency. While enrolled in a Hospice program, you may continue to receive Covered Services that are not related to the care and management of your terminal illness from the appropriate Health Care Provider. However, all care related to your terminal illness must be provided through the Hospice Agency. You may discontinue your Hospice enrollment when an acute Hospital admission is necessary, or at any other time. You may also enroll in the Hospice program again when you are discharged from the Hospital, or at any other time, with Physician recertification. Benefits include: •  Pre-Hospice consultation to discuss care options and symptom management; •  Advance care planning; •  Skilled Nursing Services; •  Medical direction and a written treatment plan approved by a Physician; •  Continuous Nursing Services provided by registered or licensed vocational nurses, eight to 24 hours per day; •  Home Health Aide services, supervised by a nurse; •  Homemaker services, supervised by a nurse, to help you maintain a safe and healthy home environment; •  Medical social services; •  Dietary counseling; •  Volunteer services by a Hospice agency; •  Short-term inpatient, Hospice house, or Hospice care, if required; •  Drugs, medical equipment, and supplies; •  Physical therapy, occupational therapy, and speech-language pathology services to control your symptoms or help your ability to perform Activities of Daily Living; •  Respiratory therapy; •  Occasional, short-term inpatient respite care when necessary to relieve your primary caregiver or family members, up to five days at a time; •  Bereavement services for your family; and •  Social services, counseling, and spiritual services for you and your family. Benefits do not include: •  Services provided by a Non-Participating Hospice Agency, except in certain circumstances where there are no Participating Hospice Agencies in your area and services are prior authorized. Benefits are available for inpatient care in a Hospital. Benefits include: •  Room and board, such as: o Semiprivate Hospital room, or private room if Medically Necessary; o Specialized care units, including adult intensive care, coronary care, pediatric and neonatal intensive care, and subacute care;

Infertility Benefits. Benefits are provided for the diagnosis and treatment of the cause of Infertility, including professional, Hospital, Ambulatory Surgery Center, and related ancillary services to diagnose and treat the cause of Infertility, with the exception of what is excluded in the Exclusions and limitations section. Fertility preservation services are covered for Members undergoing treatment or receiving Covered Services that may directly or indirectly cause iatrogenic Infertility. Under these circumstances, standard fertility preservation services are a Covered Service and do not fall under the scope of Infertility Benefits described in the Family Planning and Infertility Benefits section. Benefits are available for home health services. These services include home health agency services, home infusion and injectable medication services, and hemophilia home infusion services. Benefits are available from a Participating home health care agency for diagnostic and treatment services received in your home under a written treatment plan approved by your Physician. Benefits include: •  Intermittent home care for skilled services from: o Registered nurses; o Licensed vocational nurses; o Physical therapists; o Occupational therapists; o Speech and language pathologists; o Licensed clinical social workers; and o Home Health Aides. •  Related medical supplies. Intermittent home care is for skilled services you receive: •  Fewer than seven days per week; or •  Daily, for fewer than eight hours per day, up to 21 days. Benefits are limited to a visit maximum as shown in the Summary of Benefits section for home health agency visits. For this Benefit, coverage includes: •  Up to four three visits per day, two hours maximum per visit, with a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech and language pathologist, or licensed clinical social worker. A visit of two hours or less is considered one visit. Nursing visits cannot be combined to provide Continuous Nursing Services. •  Up to four hours maximum per visit with a Home Health Aide. A visit of four hours or less is considered one visit. Benefits do not include: •  Continuous Nursing Services provided by a registered nurse or a licensed vocational nurse, on a one-to-one basis, in an inpatient or home setting. These services may also be described as “shift care” or “private-duty nursing.” Benefits are available through a Participating home infusion agency for home infusion, enteral, and injectable medication therapy. Benefits include: •  Home infusion agency Skilled Nursing visits; •  Infusion therapy provided in an infusion suite associated with a Participating home infusion agency; •  Parenteral nutrition services and associated supplies and solutions; •  Enteral nutrition services and associated supplies and solutions; •  Medical supplies used during a covered visit; and •  Medications injected or administered intravenously. There is no Calendar Year visit maximum for home infusion agency services. This Benefit does not include: •  Insulin; •  Insulin syringes; and •  Services related to hemophilia, which are described below. Benefits are available for hemophilia home infusion products and services for the treatment of hemophilia and other bleeding disorders. Benefits must be prior authorized and provided in the home or in an infusion suite managed by a Participating Hemophilia Home Infusion Provider. Benefits include: •  24-hour service; •  Home delivery of hemophilia infusion products; •  Blood factor product; •  Supplies for the administration of blood factor product; and •  Nursing visits for training or administration of blood factor products. There is no Calendar Year visit maximum for hemophilia home infusion agency services. Benefits do not include: •  In-home services to treat complications of hemophilia replacement therapy; or •  Self-infusion training programs, other than nursing visits to assist in administration of the product. Most Participating home health care and home infusion agencies are not Participating Hemophilia Home Infusion Providers. A list of Participating Hemophilia Home Infusion Providers is available at xxxxxxxxxxxx.xxx. Benefits are available through a Participating Hospice Agency for specialized care if you have been diagnosed with a terminal illness with a life expectancy of one year or less. When you enroll in a Hospice program, you agree to receive all care for your terminal illness through the Hospice Agency. Hospice program enrollment is prior authorized for a specified period of care based on your Physician’s certification of eligibility. The period of care begins the first day you receive Hospice services and ends when the specified timeframe is over or you choose to receive care for your terminal illness outside of the Hospice program. The authorized period of care is for two 90-day periods followed by unlimited 60-day periods, depending on your diagnosis. Your Hospice care continues through to the next period of care when your Physician recertifies that you have a terminal illness. The Hospice Agency works with your Physican to ensure that your Hospice enrollment continues without interruption. You can change your Participating Hospice Agency only once during each period of care. A Hospice program provides interdisciplinary care designed to ease your physical, emotional, social, and spiritual discomfort during the last phases of life, and support your primary caregiver and your family. Hospice services are available 24 hours a day through the Hospice Agency. While enrolled in a Hospice program, you may continue to receive Covered Services that are not related to the care and management of your terminal illness from the appropriate Health Care Provider. However, all care related to your terminal illness must be provided through the Hospice Agency. You may discontinue your Hospice enrollment when an acute Hospital admission is necessary, or at any other time. You may also enroll in the Hospice program again when you are discharged from the Hospital, or at any other time, with Physician recertification. Benefits include: •  Pre-Hospice consultation to discuss care options and symptom management; •  Advance care planning; •  Skilled Nursing Services; •  Medical direction and a written treatment plan approved by a Physician; •  Continuous Nursing Services provided by registered or licensed vocational nurses, eight to 24 hours per day; •  Home Health Aide services, supervised by a nurse; •  Homemaker services, supervised by a nurse, to help you maintain a safe and healthy home environment; •  Medical social services; •  Dietary counseling; •  Volunteer services by a Hospice agency; •  Short-term inpatient, Hospice house, or Hospice care, if required; •  Drugs, medical equipment, and supplies; •  Physical therapy, occupational therapy, and speech-language pathology services to control your symptoms or help your ability to perform Activities of Daily Living; •  Respiratory therapy; •  Occasional, short-term inpatient respite care when necessary to relieve your primary caregiver or family members, up to five days at a time; •  Bereavement services for your family; and •  Social services, counseling, and spiritual services for you and your family. Benefits do not include: •  Services provided by a Non-Participating Hospice Agency, except in certain circumstances where there are no Participating Hospice Agencies in your area and services are prior authorized. Benefits are available for inpatient care in a Hospital. Benefits include: •  Room and board, such as: o Semiprivate Hospital room, or private room if Medically Necessary; o Specialized care units, including adult intensive care, coronary care, pediatric and neonatal intensive care, and subacute care;

Infertility Benefits. Benefits are provided for the diagnosis and treatment of the cause of Infertility, including professional, Hospital, Ambulatory Surgery Center, and related ancillary services to diagnose and treat the cause of Infertility, with the exception of what is excluded in the Exclusions and limitations section. Fertility preservation services are covered for Members undergoing treatment or receiving Covered Services that may directly or indirectly cause iatrogenic Infertility. Under these circumstances, standard fertility preservation services are a Covered Service and do not fall under the scope of Infertility Benefits described in the Family Planning and Infertility Benefits section. Benefits are available for home health services. These services include home health agency services, home infusion and injectable medication services, and hemophilia home infusion services. Benefits are available from a Participating home health care agency for diagnostic and treatment services received in your home under a written treatment plan approved by your Physician. Benefits include: • Intermittent home care for skilled services from: o Registered nurses; o Licensed vocational nurses; o Physical therapists; o Occupational therapists; o Speech and language pathologists; o Licensed clinical social workers; and o Home Health Aides. • Related medical supplies. Intermittent home care is for skilled services you receive: • Fewer than seven days per week; or • Daily, for fewer than eight hours per day, up to 21 days. Benefits are limited to a visit maximum as shown in the Summary of Benefits section for home health agency visits. For this Benefit, coverage includes: • Up to four three visits per day, two hours maximum per visit, with a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech and language pathologist, or licensed clinical social worker. A visit of two hours or less is considered one visit. Nursing visits cannot be combined to provide Continuous Nursing Services. • Up to four hours maximum per visit with a Home Health Aide. A visit of four hours or less is considered one visit. Benefits do not include: • Continuous Nursing Services provided by a registered nurse or a licensed vocational nurse, on a one-to-one basis, in an inpatient or home setting. These services may also be described as “shift care” or “private-private duty nursing.” Benefits are available through a Participating home infusion agency for home infusion, enteral, and injectable medication therapy. Benefits include: • Home infusion agency Skilled Nursing visits; • Infusion therapy provided in an infusion suite associated with a Participating home infusion agency; • Parenteral nutrition services and associated supplies and solutions; • Enteral nutrition services and associated supplies and solutions; • Medical supplies used during a covered visit; and • Medications injected or administered intravenously. There is no Calendar Year visit maximum for home infusion agency services. This Benefit does not include: • Insulin; • Insulin syringes; and • Services related to hemophilia, which are described below. Benefits are available for hemophilia home infusion products and services for the treatment of hemophilia and other bleeding disorders. Benefits must be prior authorized and provided in the home or in an infusion suite managed by a Participating Hemophilia Home Infusion Provider. Benefits include: • 24-hour service; • Home delivery of hemophilia infusion products; • Blood factor product; • Supplies for the administration of blood factor product; and • Nursing visits for training or administration of blood factor products. There is no Calendar Year visit maximum for hemophilia home infusion agency services. Benefits do not include: • In-home services to treat complications of hemophilia replacement therapy; or • Self-infusion training programs, other than nursing visits to assist in administration of the product. Most Participating home health care and home infusion agencies are not Participating Hemophilia Home Infusion Providers. A list of Participating Hemophilia Home Infusion Providers is available at xxxxxxxxxxxx.xxx. Benefits are available through a Participating Hospice Agency for specialized care if you have been diagnosed with a terminal illness with a life expectancy of one year or less. When you enroll in a Hospice program, you agree to receive all care for your terminal illness through the Hospice Agency. Hospice program enrollment is prior authorized for a specified period of care based on your Physician’s certification of eligibility. The period of care begins the first day you receive Hospice services and ends when the specified timeframe is over or you choose to receive care for your terminal illness outside of the Hospice program. The authorized period of care is for two 90-day periods followed by unlimited 60-day periods, depending on your diagnosis. Your Hospice care continues through to the next period of care when your Physician recertifies that you have a terminal illness. The Hospice Agency works with your Physican Physician to ensure that your Hospice enrollment continues without interruption. You can change your Participating Hospice Agency only once during each period of care. A Hospice program provides interdisciplinary care designed to ease your physical, emotional, social, and spiritual discomfort during the last phases of life, and support your primary caregiver and your family. Hospice services are available 24 hours a day through the Hospice Agency. While enrolled in a Hospice program, you may continue to receive Covered Services that are not related to the care and management of your terminal illness from the appropriate Health Care Provider. However, all care related to your terminal illness must be provided through the Hospice Agency. You may discontinue your Hospice enrollment when an acute Hospital admission is necessary, or at any other time. You may also enroll in the Hospice program again when you are discharged from the Hospital, or at any other time, with Physician recertification. Benefits include: • Pre-Hospice consultation to discuss care options and symptom management; • Advance care planning; • Skilled Nursing Services; • Medical direction and a written treatment plan approved by a Physician; • Continuous Nursing Services provided by registered or licensed vocational nurses, eight to 24 hours per day; • Home Health Aide services, supervised by a nurse; • Homemaker services, supervised by a nurse, to help you maintain a safe and healthy home environment; • Medical social services; • Dietary counseling; • Volunteer services by a Hospice agency; • Short-term inpatient, Hospice house, or Hospice care, if required; • Drugs, medical equipment, and supplies; • Physical therapy, occupational therapy, and speech-language pathology services to control your symptoms or help your ability to perform Activities of Daily Living; • Respiratory therapy; • Occasional, short-term inpatient respite care when necessary to relieve your primary caregiver or family members, up to five days at a time; • Bereavement services for your family; and • Social services, counseling, and spiritual services for you and your family. Benefits do not include: • Services provided by a Non-Participating Hospice Agency, except in certain circumstances where there are no Participating Hospice Agencies in your area and services are prior authorized. Benefits are available for inpatient care in a Hospital. Benefits include: • Room and board, such as: o Semiprivate Hospital room, or private room if Medically Necessary; o Specialized care units, including adult intensive care, coronary care, pediatric and neonatal intensive care, and subacute care;

Infertility Benefits. Benefits are provided for the diagnosis and treatment of the cause of Infertility, including professional, Hospital, Ambulatory Surgery Center, and related ancillary services to diagnose and treat the cause of Infertility, with the exception of what is excluded in the Exclusions and limitations section. Fertility preservation services are covered for Members undergoing treatment or receiving Covered Services that may directly or indirectly cause iatrogenic Infertility. Under these circumstances, standard fertility preservation services are a Covered Service and do not fall under the scope of Infertility Benefits described in the Family Planning and Infertility Benefits section. Benefits are available for home health services. These services include home health agency services, home infusion and injectable medication services, and hemophilia home infusion services. Benefits are available from a Participating home health care agency for diagnostic and treatment services received in your home under a written treatment plan approved by your Physician. Benefits include: • Intermittent home care for skilled services from: o Registered nurses; o Licensed vocational nurses; o Physical therapists; o Occupational therapists; o Speech and language pathologists; o Licensed clinical social workers; and o Home Health Aides. • Related medical supplies. Intermittent home care is for skilled services you receive: • Fewer than seven days per week; or • Daily, for fewer than eight hours per day, up to 21 days. Benefits are limited to a visit maximum as shown in the Summary of Benefits section for home health agency visits. For this Benefit, coverage includes: • Up to four three visits per day, two hours maximum per visit, with a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech and language pathologist, or licensed clinical social worker. A visit of two hours or less is considered one visit. Nursing visits cannot be combined to provide Continuous Nursing Services. • Up to four hours maximum per visit with a Home Health Aide. A visit of four hours or less is considered one visit. Benefits do not include: • Continuous Nursing Services provided by a registered nurse or a licensed vocational nurse, on a one-to-one basis, in an inpatient or home setting. These services may also be described as “shift care” or “private-duty nursing.” Benefits are available through a Participating home infusion agency for home infusion, enteral, and injectable medication therapy. Benefits include: • Home infusion agency Skilled Nursing visits; • Infusion therapy provided in an infusion suite associated with a Participating home infusion agency; • Parenteral nutrition services and associated supplies and solutions; • Enteral nutrition services and associated supplies and solutions; • Medical supplies used during a covered visit; and • Medications injected or administered intravenously. There is no Calendar Year visit maximum for home infusion agency services. This Benefit does not include: • Insulin; • Insulin syringes; and • Services related to hemophilia, which are described below. Benefits are available for hemophilia home infusion products and services for the treatment of hemophilia and other bleeding disorders. Benefits must be prior authorized and provided in the home or in an infusion suite managed by a Participating Hemophilia Home Infusion Provider. Benefits include: • 24-hour service; • Home delivery of hemophilia infusion products; • Blood factor product; • Supplies for the administration of blood factor product; and • Nursing visits for training or administration of blood factor products. There is no Calendar Year visit maximum for hemophilia home infusion agency services. Benefits do not include: • In-home services to treat complications of hemophilia replacement therapy; or • Self-infusion training programs, other than nursing visits to assist in administration of the product. Most Participating home health care and home infusion agencies are not Participating Hemophilia Home Infusion Providers. A list of Participating Hemophilia Home Infusion Providers is available at xxxxxxxxxxxx.xxx. Benefits are available through a Participating Hospice Agency for specialized care if you have been diagnosed with a terminal illness with a life expectancy of one year or less. When you enroll in a Hospice program, you agree to receive all care for your terminal illness through the Hospice Agency. Hospice program enrollment is prior authorized for a specified period of care based on your Physician’s certification of eligibility. The period of care begins the first day you receive Hospice services and ends when the specified timeframe is over or you choose to receive care for your terminal illness outside of the Hospice program. The authorized period of care is for two 90-day periods followed by unlimited 60-day periods, depending on your diagnosis. Your Hospice care continues through to the next period of care when your Physician recertifies that you have a terminal illness. The Hospice Agency works with your Physican to ensure that your Hospice enrollment continues without interruption. You can change your Participating Hospice Agency only once during each period of care. A Hospice program provides interdisciplinary care designed to ease your physical, emotional, social, and spiritual discomfort during the last phases of life, and support your primary caregiver and your family. Hospice services are available 24 hours a day through the Hospice Agency. While enrolled in a Hospice program, you may continue to receive Covered Services that are not related to the care and management of your terminal illness from the appropriate Health Care Provider. However, all care related to your terminal illness must be provided through the Hospice Agency. You may discontinue your Hospice enrollment when an acute Hospital admission is necessary, or at any other time. You may also enroll in the Hospice program again when you are discharged from the Hospital, or at any other time, with Physician recertification. Benefits include: • Pre-Hospice consultation to discuss care options and symptom management; • Advance care planning; • Skilled Nursing Services; • Medical direction and a written treatment plan approved by a Physician; • Continuous Nursing Services provided by registered or licensed vocational nurses, eight to 24 hours per day; • Home Health Aide services, supervised by a nurse; • Homemaker services, supervised by a nurse, to help you maintain a safe and healthy home environment; • Medical social services; • Dietary counseling; • Volunteer services by a Hospice agency; • Short-term inpatient, Hospice house, or Hospice care, if required; • Drugs, medical equipment, and supplies; • Physical therapy, occupational therapy, and speech-language pathology services to control your symptoms or help your ability to perform Activities of Daily Living; • Respiratory therapy; • Occasional, short-term inpatient respite care when necessary to relieve your primary caregiver or family members, up to five days at a time; • Bereavement services for your family; and • Social services, counseling, and spiritual services for you and your family. Benefits do not include: • Services provided by a Non-Participating Hospice Agency, except in certain circumstances where there are no Participating Hospice Agencies in your area and services are prior authorized. Benefits are available for inpatient care in a Hospital. Benefits include: • Room and board, such as: o Semiprivate Hospital room, or private room if Medically Necessary; o Specialized care units, including adult intensive care, coronary care, pediatric and neonatal intensive care, and subacute care;