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. 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. Covered with no wait. 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. • 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. Not covered. Covered up to sixty (60) days per Member per calendar year. Covered subject to the lesser of GHC’s charge or the applicable Copayment. • 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. • 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. Not a covered service.
Podiatric Services. 150 6.1.42 Prescription Drugs and Over-the-Counter Drugs 150
Podiatric Services. Medically Necessary foot care • Foot care (routine)
Podiatric Services. Medically Necessary foot care Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. • Foot care (routine) Not covered, except in the presence of a non-related Medical Condition affecting the lower limbs. Covered with no wait. Covered in full when in accordance with the well care schedule established by GHC and the Patient Protection and Affordable Care Act of 2010. Not subject to the annual Deductible or any applicable Plan Coinsurance. Eye refractions are not included under preventive care. Physicals for travel, employment, insurance or license are not covered. Services provided during a preventive care visit which are not in accordance with the well care schedule may be subject to the lesser of GHC’s charge or the applicable outpatient services Cost Share. • 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 and at the Plan Coinsurance for up to sixty (60) days per calendar year after the annual Deductible is satisfied. • 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. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. Not covered. Covered at the Plan Coinsurance for up to sixty (60) days per Member per calendar year after the annual Deductible is satisfied. Covered subject to the lesser of GHC’s charge or the applicable Cost Share. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. • Inpatient and outpatient TMJ services Covered subject to the lesser of GHC’s charge or the applicable Copayment and at the Plan Coinsurance for up to $1,000 maximum per Member per calendar year after the annual Deductible is satisfied. Annual Deductible and Plan Coinsurance do not apply to office visits, but do apply to office based procedures and surgical services. • Lifetime bene...
