Private Duty Nursing. The Plan does not provide Benefits for private duty or block nursing services. Skilled nursing visits greater than two (2) hours per day are not covered. Block nursing to monitor or provide nursing coverage greater than two (2) hours per day is not covered.
Private Duty Nursing. Services provided in your home (other than custodial care, homemaking services and supervision) by a Registered Nurse, a Registered Nursing Assistant, a Certified Nursing Assistant, or a Licensed Practical Nurse, to a maximum of
Private Duty Nursing. Private duty nursing* Must be performed by a certified home health care agency. 0% - After Deductible 20% - After Deductible
Private Duty Nursing. Respite care. This exclusion does not apply to respite care for which Benefits are provided as described under Hospice Care in Section 1: Covered Health Care Services.
Private Duty Nursing. Private duty nursing at home when medically necessary to a maximum of $15,000.00 for every three benefit years. Effective April 1, 2010, private duty nursing at home when medically necessary to a maximum of $25,000 for every three benefit years.
Private Duty Nursing. Private Duty Nursing services provided in the home when provided through a Home Health Agency and authorized in advance by us. Your Physician must certify to us that Private Duty Nursing services are Medically Necessary for your condition and not merely custodial in nature. Private Duty Nursing services may be provided if they are determined by us to be more cost effective than can be provided in a Facility setting. Hospice care that is recommended by a Physician. Hospice care is an integrated program that provides comfort and support services for the terminally ill. It includes the following: • Physical, psychological, social, spiritual and respite care for the terminally ill person. • Short-term grief counseling for immediate family members while you are receiving hospice care. Benefits are available when you receive hospice care from a licensed hospice agency. You can call us at the telephone number on your ID card for information about our guidelines for hospice care. Services and supplies provided during an Inpatient Stay in a Hospital. Benefits are available for: • Supplies and non-Physician services received during the Inpatient Stay. • Room and board in a Semi-private Room (a room with two or more beds) or a private room when Medically Necessary. • Physician services for radiologists, anesthesiologists, pathologists and Emergent ER Services Physicians. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) With respect to treatment of breast cancer and other breast conditions, we will pay Benefits for an Inpatient Stay of at least: • 48 hours following a mastectomy, • 24 hours following a lymph node dissection. Services for Sickness and Injury-related diagnostic purposes, received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office include: • Lab and radiology/X-ray. • Diagnostic Examination for Breast Cancer, including digital mammography and Breast Tomosynthesis. Benefits include: SAMPLE • The facility charge and the charge for supplies and equipment. • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) • Genetic Testing ordered by a Physician which results in available medical treatment options following Genetic Counseling. • Presumptive Drug Tests and Definitive Drug Tests. • Medically necessary biomarker testing for the purpos...
Private Duty Nursing. Maximum: $10,000 in a calendar year Provided you do not reside in a convalescent nursing home and the nurse is not a relative, charges for medically necessary home nursing care performed by a registered nurse, registered nursing assistant or certified nursing assistant are eligible. Written authorization of the attending physician is required. In addition, services provided by an approved personal care worker are eligible under this benefit for up to 4 hours per day. Personal care workers offer essential services such as bathing, dressing, toileting, feeding and mobilization. The covered person may be eligible for services in his/her home if under the active care of a nurse or if requiring home care during the recuperation period after a discharge from the hospital and requires temporary home care. All nursing services must be pre-approved by Medavie Blue Cross in order to be considered for reimbursement.
Private Duty Nursing. Non-medical, provider services, including, but not limited to:
Private Duty Nursing. On the written recommendation of the insured's doctor, charges will be covered for nursing visits in the insured's home. They must be provided by a professional nurse who is not related by blood, or connected by marriage, not a close friend or does not normally reside in the insured's home. Nursing services must be consistent with the insured's diagnosis and treatment of the condition and not primarily for custodial care. A Nursing Care Questionnaire is required and approval is at the discretion of the Insurance Company. Maximum payment is $25,000 per insured in any consecutive 24 month period. The plan will pay up to a maximum of $300 per person each calendar year per practitioner listed below provided such practitioner is operating within the scope of his licence. Charges for group sessions are not eligible expenses. - naturopaths, excluding food supplements or vitamins; - licensed physiotherapists; - chiropractors, including one diagnostic x-ray per year; - practitioners registered in the Christian Science Journal; - osteopaths; - podiatrists or chiropodists; - qualified acupuncturists; - audiologists; - registered massage therapists; - registered dietician (upon written referral from a physician), excluding fees for weight loss programs. Services of licensed clinical psychologists/social workers and licensed speech therapists are covered up to $600 per person per calendar year. All Paramedical Services have a combined annual maximum of $2,500 per certificate. Please Note: Where applicable, expenses will not be paid until the insured's expenses exceed the maximums under the provincial health plan. In Ontario, proof that the provincial plan maximum is exhausted will be required. When prescribed by their attending physician, cardiac patients may participate in a recognized rehabilitation program after a heart attack, bypass surgery, valve replacement or management of angina pectoris. The benefit has a lifetime maximum of $300 per individual.
