Transplants All solid human organ and bone marrow/stem cell transplants must be certified as medically necessary by Intracorp and are subject to the following provisions:
The condition requiring the transplant is life-threatening;
The transplant for the condition is the subject of an ongoing phase III clinical trial or has been approved by US Food and Drug Administration;
The procedure follows a written protocol that has been reviewed and approved by an institutional review board, federal agency, or other such organization recognized by medical specialists who have appropriate expertise; and
The participant is a suitable candidate for the transplant under the medical protocols used by Intracorp.
For benefits to be paid at the in-network benefit level, the facility where the transplant is performed must be approved by Intracorp.
Organ Acquisition Coverage Benefits are provided for surgical, storage, and transportation expenses incurred and directly related to the donation of an organ or bone marrow/stem cell used in a covered transplant procedure. If any organ or bone marrow/stem cell is sold rather than donated to the participant, no benefits will be payable for the purchase price. Costs related to evaluation and procurement are covered.
Travel Expenses Related to Transplant Transportation costs of the transplant recipient and one other person to and from the surgery site, as well as reasonable and necessary cost of meals and lodging for the accompanying person, are covered. If the recipient is a minor, reasonable and necessary expenses for the transportation, meals, and lodging of two other accompanying persons are covered.
Only those travel expenses incurred at the time of the transplant surgery are eligible for reimbursement. Travel expenses incurred as a result of pre-operative and post-operative services are not eligible for reimbursement. The Plan will only reimburse actual travel expenses supported by dated receipts. The amount of reimbursement will not exceed $10,000 for any single transplant episode.