HomeMy WebLinkAboutRESPONSE - RFP - P682 BENEFITS (10)IN -NETWORK
OUT -OF -NETWORK
25. HOME HEALTH CARE
90% up to 60 visits per calendar
70% up to 60 visits per calendar year.
year.
6. HOSPICE CARE
90% up to 365 days per lifetime.
70% up to 365 days per lifetime.
27. SKILLED NURSING FACILITY
90% up to 90 days per calendar
70% up to 90 days per calendar year
CARE
year when preauthorized; $250
when preauthorized; $250 additional
additional deductible when not
deductible when not preauthorized.
preauthorized.
28. DENTAL CARE
Available as a separate dental
Available as a separate dental care
care plan or as an optional
plan or as an optional benefit.
benefit.
29. VISION CARE
Available as a separate vision
Available as a separate vision care
care plan or as an optional
plan or as an optional benefit.
benefit.
30. CHIROPRACTIC CARE
$20 copayment; limited to $10
70%; limited to $10 payment per visit,
payment per visit, 50 visits per
limited to 50 visits per calendar year.
calendar year.
31. SIGNIFICANT ADDITIONAL
Routine mammograms - no
Routine mammograms - no deductible
COVERED SERVICES (list up to 5)
deductible 100%, prostate cancer
100%, prostate cancer screening - no
screening - no deductible 100%,
deductible 100"/u, Preventive Child Health
Preventive Child Health
Supervision Services - no deductible 70%,
Supervision Services - $20
infertility evaluation - 70%; see plan
copayment, infertility evaluation -
booklet for limitations on all of these
$20 copayment; see plan booklet
services.
for limitations on all of these
services.
PART C: LIMITATIONS AND EXCLUSIONS
32. PERIOD DURING WHICH PRE-EXISTING
6 months for all pre-existing conditions. See plan
CONDITIONS ARE NOT COVERED.5
booklet for details.
33. EXCLUSIONARY RIDERS. Can an individual's specific,
No.
pre-existing condition be entirely excluded from the policy?
34. HOW DOES THE POLICY DEFINE A "PRE-EXISTING
A pre-existing condition is a condition for which
CONDITION"?
medical advice, diagnosis, care, or treatment was
recommended or received within the last 3 months
immediately preceding the date of enrollment or, if
earlier, the fast day of the waiting period; except that
pre-existing condition exclusions may not be imposed
on a newly adopted child, a child placed for adoption,
a newborn, other special enrollees, or for pregnancy.
35. WHAT TREATMENTS AND CONDITIONS ARE
Exclusions vary by policy. A list of exclusions is
EXCLUDED UNDER THIS POLICY?
available immediately upon request from your
carrier, agent, or plan sponsor (e.g., employer). It
is important to review them to see if a service or
treatment you may need is excluded from the
policy.
s Waiver of ore -existing condition exclusions. State law requires carriers to waive some or all of the pre-existing condition exclusion
period based on other coverage you recently may have had. Ask your carrier or plan sponsor (e.g., employer) for details.