Skip to main content
Toggle Menu

HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Includes bereavement and respite care. Hospice care services, including pre-hospice evaluation or consultation, are covered when the member is terminally ill and expected to live 6 months or less, potentially curative treatment for the terminal illness is not part of the prescribed plan of care, the member or appointed designee has formally consented to hospice care (i.e., care directed mostly toward palliative care and symptom management) and the hospice services are provided by a certified/accredited hospice agency with care available 24 hours per day, 7 days per week.

The following levels of hospice care services are covered when the above criteria have been met:

  • Assessment of the medical and social needs of the terminally ill person, and a description of the care to meet those needs;
  • Inpatient care in a facility when needed for pain control and other acute and chronic symptom management, psychological and dietary counseling, physical or occupational therapy, and part-time home health care services;
  • Outpatient care for other services as related to the terminal illness, which include services of a physician; physical or occupational therapy; and nutrition counseling provided by or under the supervision of a registered dietitian; or
  • Bereavement counseling benefits which are received by a member's close relative when directly connected to the member's death and bundled with other hospice charges. The services must be furnished within 12 months of death.

Preauthorization by medical plan is required.


Back to Top