Podiatric Services. Medically Necessary foot care Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Foot care (routine) Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs. Pre-Existing Condition Covered with no wait. Preventive Services (well adult and well child physicals, immunizations, pap smears, mammograms and prostate/colorectal cancer screening) Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment when in accordance with the well care schedule established by GHC. Eye refractions are not included under preventive care. Physicals for travel, employment, insurance or license are not covered. Rehabilitation Services • Inpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable inpatient services Copayment for up to sixty (60) days per calendar year. • Outpatient physical, occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six (6) and under Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment for up to sixty (60) visits per calendar year. Sexual Dysfunction Services Not covered. Skilled Nursing Facility (SNF) Covered up to sixty (60) days per Member per calendar year. Sterilization (vasectomy, tubal ligation) Covered subject to the lesser of GHC’s charge or the applicable Copayment. Temporomandibular Joint (TMJ) Services • Inpatient and outpatient TMJ services Covered subject to the lesser of GHC’s charge or the applicable Copayment up to $1,000 maximum per Member per calendar year. • Lifetime benefit maximum Covered up to $5,000 per Member. Tobacco Cessation • Individual/group counseling Covered in full when received through the GHC-designated tobacco cessation program. • Approved pharmacy products Covered in full when prescribed as part of the GHC-designated tobacco cessation program and dispensed through the GHC-designated mail order service.
Podiatric Services. 152 6.1.42 Prescription Drugs and Over-the-Counter Drugs. 152 6.1.43 Medication Therapy Management (MTM) Care Services. 158 6.1.44 Prescribing, Electronic 158 6.1.45 Prosthetic and Orthotic Devices. 158
Podiatric Services. 150 6.1.42 Prescription Drugs and Over-the-Counter Drugs 150
Podiatric Services. Medically Necessary foot care MHCN: Covered subject to the lesser of the MHCN’s charge or the applicable outpatient services Copayment and at the Plan Coinsurance after the annual Deductible is satisfied. Community Provider: Covered subject to the lesser of the allowed charge or the applicable outpatient services Copayment and at the Plan Coinsurance after the annual Deductible is satisfied. • Foot care (routine) MHCN: Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs.
Podiatric Services. Not a covered service.
