Common use of Rehabilitation Benefits Clause in Contracts

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.