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OAC 365:10


and frequency of at-home recovery services are necessary because of a condition for which a home care plan of treatment was approved by Medicare.

        • (iii)

          Coverage is limited to:

          • (I)

            No more than the number and type of at-home recovery visits certified as necessary by the insured's attending physician. The total number of at-home recovery visits shall not exceed the number of Medicare approved home health care visits under a Medicare approved home care plan of treatment;

          • (II)

            The actual charges for each visit up to a maximum reimbursement of forty dollars ($40) per visit;

          • (III)

            One thousand six hundred dollars ($1,600) per calendar year;

          • (IV)

            Seven (7) visits in any one week;

          • (V)

            Care furnished on a visiting basis in the insured's home;

          • (VI)

            Services provided by a care provider as defined in this section;

          • (VII)

            At-home recovery visits while the insured is covered under the policy or certificate and not otherwise excluded;

          • (VIII)

            At-home recovery visits received during the period the insured is receiving Medicare approved home care services or no more than eight (8) weeks after the service date of the last Medicare approved home health care visit.

      • (C)

        Coverage is excluded for:

        • (i)

          Home care visits paid for by Medicare or other government programs; and

        • (ii)

          Care provided by family members, unpaid volunteers or providers who are not care providers.

  • (e)

    Standards for Plans K and L

    • (1)

      Standardized Medicare supplement benefit plan “K” shall consist of the following:

      • (A)

        Coverage of One Hundred percent (100%) of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

      • (B)

        Coverage of One Hundred percent (100%) of the Part a Hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period:

      • (C)

        Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expense for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit an an additional 365 days. The provider shall accept the issuer’s payment as payment in full and may not bill the insured for any balance;

      • (D)

        Medicare Part A Deductible: Coverage for Fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out- of-pocket limitation is met as described in subparagraph (J);

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