Rehabilitation Benefits. If a salaried employee is absent with rehabilitation benefits during a period when the employee would otherwise be entitled to sick pay under 10.3.8, salary deductions shall be made as for illness from the 15th calendar day according to 10.3.6.
Rehabilitation Benefits. The following benefits are covered by Participating Providers upon Referral issued by the Member’s PCP and pre-authorization by HMO.
1. A limited course of cardiac rehabilitation following an inpatient Hospital stay is covered when Medically Necessary following angioplasty, cardiovascular surgery, congestive heart failure or myocardial infarction.
2. Pulmonary rehabilitation following an inpatient Hospital stay is covered when Medically Necessary for the treatment of reversible pulmonary disease states.
3. Cognitive therapy associated with physical rehabilitation is covered for non-chronic conditions and acute illnesses and injuries as part of a treatment plan coordinated with HMO. Coverage is subject to the limits, if any, shown on the Schedule of Benefits.
4. Physical therapy is covered for non-chronic conditions and acute illnesses and injuries. Coverage is subject to the limits, if any, shown on the Schedule of Benefits.
5. Occupational therapy (except for vocational rehabilitation or employment counseling) is covered for non-chronic conditions and acute illnesses. Coverage is subject to the limits, if any, shown on the Schedule of Benefits.
6. Speech therapy is covered for non-chronic conditions and acute illnesses and injuries and is subject to the limits, if any, shown on the Schedule of Benefits. Services rendered for the treatment of delays in speech development, unless resulting from disease, injury, or congenital defects, are not covered.
Rehabilitation Benefits. The following benefits are covered when rendered by Participating Providers upon Referral issued by the Member’s PCP and pre-authorized by HMO.
Rehabilitation Benefits. The rehabilitation benefit is designed to help you, as a disabled individual, return to gainful employment and therefore a more productive lifestyle. Rehabilitation involves a training strategy or work related activity that: can be expected to facilitate your return to your own or another job; and is recommended or approved by the disability carrier. In considering whether or not a rehabilitation proposal is appropriate, the adjudicator assesses such factors as the expected duration of disability, and the level of activity required to facilitate the earliest possible return to employment. To be classified as a comprehensive rehabilitation program, the goal must be to return to work:
Rehabilitation Benefits. The following benefits are covered when Medically Necessary, provided by Participating Providers upon Referral issued by the Member’s PCP and pre-authorized by HMO.
1. Cardiac rehabilitation benefits are available as part of a Member’s inpatient Hospital stay. A limited course of outpatient cardiac rehabilitation is covered when Medically Necessary following angioplasty, cardiovascular surgery, congestive heart failure or myocardial infarction.
2. Pulmonary rehabilitation benefits are available as part of a Member’s inpatient Hospital stay. A limited course of outpatient pulmonary rehabilitation is covered when Medically Necessary for the treatment of reversible pulmonary disease states.
3. Cognitive therapy for medical conditions is covered when the cognitive deficits have been acquired as a result of neurologic impairment due to trauma, stroke, or encephalopathy based upon a written treatment plan that supports the Member’s ability to progress toward the treatment goals. The treatment plan is coordinated with HMO. Cognitive therapy is also covered for behavioral health conditions provided the therapy is Coverage is subject to the limits, if any, shown on the Schedule of Benefits. For inpatient cognitive therapy benefits refer to the Inpatient Hospital and Skilled Nursing Facility benefit provisions under the Covered Benefits section of this Evidence of Coverage.
4. Physical therapy is covered to diagnose and treat physical and mental health conditions based upon a written treatment plan that supports the Member’s ability to progress toward the treatment goals. The treatment plan is coordinated with HMO. Coverage is subject to the limits, if any, shown on the Schedule of Benefits. For inpatient physical therapy benefits refer to the Inpatient Hospital and Skilled Nursing Facility benefit provisions under the Covered Benefits section of this Evidence of Coverage.
5. Occupational therapy is covered to diagnose and treat physical and mental health conditions based upon a written treatment plan that supports the Member’s ability to progress toward the treatment goals. The treatment plan is coordinated with HMO. Coverage is subject to the limits, if any, shown on the Schedule of Benefits. For inpatient physical the occupational benefits refer to the Inpatient Hospital and Skilled Nursing Facility benefit provisions under the Covered Benefits section of this Evidence of Coverage.
6. Speech therapy is covered to diagnose and treat physical and mental health cond...
Rehabilitation Benefits. The following benefits are covered when rendered by Participating Providers upon Referral issued by the Member’s PCP and pre-authorized by HMO:
1. Cardiac and Pulmonary Rehabilitation Benefits.
a. Cardiac rehabilitation benefits are available as part of a Member’s inpatient Hospital stay. A limited course of outpatient cardiac rehabilitation is covered when Medically Necessary following angioplasty, cardiovascular surgery, congestive heart failure or myocardial infarction.
b. Pulmonary rehabilitation benefits are available as part of a Member’s inpatient Hospital stay. A limited course of outpatient pulmonary rehabilitation is covered when Medically Necessary for the treatment of reversible pulmonary disease states.
2. Cognitive Therapy, Physical Therapy, Occupational Therapy and Speech Therapy Rehabilitation Benefits. Coverage is subject to the limits, if any, shown on the Schedule of Benefits. For inpatient rehabilitation benefits for the services listed below, refer to the Inpatient Hospital and Skilled Nursing Facility benefits provision under the Covered Benefits section of this Certificate.
a. Cognitive therapy related to physical rehabilitation is covered when the cognitive deficits have been acquired as a result of a neurologic impairment due to: trauma; stroke or encephalopathy; and when the therapy is coordinated with HMO as part of a treatment plan intended to restore previous cognitive function.
b. Physical therapy is covered for non-chronic conditions and acute illnesses and injuries.
c. Occupational therapy is covered for non-chronic conditions and acute illness or injury. This does not mean vocational rehabilitation or counseling for work.
d. Speech therapy is covered for non-chronic conditions and acute illness or injury. For the treatment of Mental Disorders, the rule that any of therapies listed above be for non-chronic conditions does not apply. Therapies for the treatment of delays in development, unless resulting from acute illness or injury, or congenital defects amenable to surgical repair (such as cleft lip/palate), are covered subject to a maximum of 40 visits per condition. This maximum will not apply to Mental Disorders which will be paid subject to the same terms and conditions as any other illness. Refer to the Outpatient Patient Rehabilitation Benefits section of the Schedule of Benefits for applicable Member cost-sharing.
Rehabilitation Benefits
