Common use of Inpatient Hospital and Skilled Nursing Facility Benefits Clause in Contracts

Inpatient Hospital and Skilled Nursing Facility Benefits. A Member is covered for services only at Participating Hospitals and Participating Skilled Nursing Facilities. All services are subject to pre-authorization by HMO. In the event that the Member elects to remain in the Hospital or Skilled Nursing Facility after the date that the Participating Provider and/or the HMO Medical Director has determined and advised the Member that the Member no longer meets the criteria for continued inpatient confinement, the Member shall be fully responsible for direct payment to the Hospital or Skilled Nursing Facility for such additional Hospital, Skilled Nursing Facility, Physician and other Provider services, and HMO shall not be financially responsible for such additional services. Coverage for Skilled Nursing Facility benefits is subject to the maximum number of days, if any, shown on the Schedule of Benefits. Inpatient Hospital cardiac and pulmonary rehabilitation services are covered by Participating Providers upon Referral issued by the Member’s PCP and pre-authorization by HMO.