X hits on this document

262 views

0 shares

0 downloads

0 comments

4 / 113

Ambulance

24

Ambulatory Surgical Facility

24

Cardiac Rehabilitation – Outpatient

24

Chiropractic Services

25

Dental Services

25

Diagnostic Services – X-rays and Laboratory Services

26

Durable Medical Equipment

26

Emergency Room Services

26

Home Infusion Therapy

26

Hospital Services

27

Mastectomy

27

Maternity

27

Medical Supplies

29

Mental Health Services

29

Nursing Services – Private Duty and Home Health

29

Occupational Therapy

30

Physical Therapy

30

Physician Services

30

Organ Acquisition Coverage

32

Travel Expenses Related to Transplant

32

Living Donor Coverage

33

Special Enrollment Periods Resulting from Loss of Coverage

20

Special Enrollment Period as a Result of Gaining a New Dependent 21

Special Enrollment Period for a Dependent Returning to

Creditable Coverage

22

Transferring Within The Plan

22

School Employee Coverage During Summer Months

22

Address Changes

23

When Coverage Ends

23

Canceling Dependent Coverage

23

Multiple Surgery Prosthetic or Orthotic Devices Sleep Disorders Speech Therapy Substance Abuse Temporal Mandibular Joint Syndrome Transplants

30 31 31 31 31 31 32

Well-Child Care Well-Child Care (High Option for Children) Wellness/Preventive Coverage for Adults Medical Management and Utilization Review Notification Requirements Certifying a Hospital Admission Certifying Maternity Care and Hospitalization Certifying an Emergency Hospital Admission

33 33 34 35 35 36 36 36

Covered Services

Full-time Student Status

21

24

iii

Document info
Document views262
Page views262
Page last viewedWed Dec 07 09:03:07 UTC 2016
Pages113
Paragraphs2271
Words37586

Comments