Skilled home health nursing care is covered for members who are homebound because of injury or illness (i.e., the member leaves home only with considerable and taxing effort, and absences from home are infrequent or of short duration, or to receive medical care).
Covered services can include:
- Home visits instead of visits to the provider's office that do not exceed the usual and customary charge to perform the same service in a provider's office;
- Intermittent nurse services. Benefits are paid for only one nurse at any one time, not to exceed four hours per 24-hour period;
- Nutrition counseling provided by or under the supervision of a registered dietitian;
- Physical, occupational, respiratory and speech therapy provided by or under the supervision of a licensed therapist; or
- Medical supplies, drugs or medication prescribed by a provider, and laboratory services to the extent that the plan would have covered them under this plan if the covered person had been in a hospital.
A home health care visit is defined as: A visit by a nurse providing intermittent nurse services (each visit includes up to a four-hour consecutive visit in a 24-hour period if clinical eligibility for coverage is met) or a single visit by a therapist or a registered dietitian.
Benefits cannot be provided for any of the following:
- Homemaker or housekeeping services;
- Supportive environment materials such as handrails, ramps, air conditioners and telephones;
- Services performed by family members or volunteer workers;
- "Meals on Wheels" or similar food service;
- Separate charges for records, reports or transportation;
- Expenses for the normal necessities of living such as food, clothing and household supplies; or
- Legal and financial counseling services.
Preauthorization by medical plan is required.