SKILLED NURSING FACILITY SERVICES. The Plan provides Benefits for Inpatient Skilled Nursing Facility services. The Plan does not cover Custodial Care. Benefits are limited to 150 days per Member per Calendar Year.
SKILLED NURSING FACILITY SERVICES. 1. Services rendered in a Skilled Nursing Facility to the same extent benefits are available to an Inpatient of a Hospital. Benefits for Skilled Nursing Facility Services cannot exceed the Maximum number of days shown in SECTION SB - SCHEDULE OF BENEFITS of this Agreement.
SKILLED NURSING FACILITY SERVICES. See Section 15, Utilization Management, for Covered Services that require prior authorization.
SKILLED NURSING FACILITY SERVICES. Care in a skilled nursing facility will be covered on an out-of-network basis at 60% of the MAA, after the deductible is met. (Amend the following sections of the FMEP: Sections 5.2.3 and 11.)
SKILLED NURSING FACILITY SERVICES. See the Prior Authorization Amendment for Covered Services that may require prior authorization.
SKILLED NURSING FACILITY SERVICES. See the Prior Authorization Amendment for Covered Services that may require prior authorization. CareFirst BlueChoice provides coverage for the services listed below in a Contracting Provider Skilled Nursing Facility when admitted under the care of a Primary Care Physician or other Contracting Physician. Prior authorization is required.
SKILLED NURSING FACILITY SERVICES. Services are limited to the following and require Precertification by the PPO in accordance with Section 2 of this Certificate: Covered Services, including room and board on a skilled bed status, in a skilled nursing facility, is covered for the first sixty (60) days of any Period of Confinement. A Period of Confinement shall be defined as the period of time from the date of admission in a skilled nursing facility to the date of discharge. With respect to a Period of Confinement, the date of admission is counted as one (1) day and the date of discharge is not counted. If a Member is discharged from a skilled nursing facility and then readmitted for the same or a related condition within six (6) months, the second admission shall be counted as a continuation of the prior Period of Confinement.
SKILLED NURSING FACILITY SERVICES. Skilled Nursing Facility services provided as an alternative to Medically Necessary inpatient Hospital services. Please note that Benefits are available only when Skilled Nursing Facility services are provided as an alternative to a Medically Necessary Inpatient Stay in a Hospital and are not Custodial Care. Skilled care is skilled nursing, skilled teaching and skilled rehabilitation services when all of the following are true: • It must be delivered or supervised by licensed technical or professional medical personnel in order to obtain the specified medical outcome, and provide for the safety of the patient. • It is ordered by a Physician. • It is not delivered for the purpose of assisting with activities of daily living, including dressing, feeding, bathing or transferring from a bed to a chair. • It requires clinical training in order to be delivered safely and effectively. We will determine if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. A service will not be determined to be "skilled" simply because there is not an available caregiver. Benefits can be denied or shortened for Covered Persons who are not progressing in goal-directed rehabilitation services or if discharge rehabilitation goals have previously been met.
SKILLED NURSING FACILITY SERVICES. 1. Hospital Services provided to an Inpatient of a Plan-approved Skilled Nursing Facility.
SKILLED NURSING FACILITY SERVICES. Care in a skilled nursing facility will be covered on an out-of-network basis at 70% of the MAA, after the deductible is met. The provisions of Section 11.3 of the VMEP that set forth limits applicable to days of confinement for skilled nursing facility services will be deleted. (Amend the following sections of the VMEP: Sections 5.2.3 and 11.)
