56 Preventive Care for Chronic Conditions (per IRS guidelines) Members with certain chronic health conditions may be able to receive preventive care for those conditions prior to meeting their Deductible, when services are provided by an In-Network Provider. These benefits are available if the care qualifies under guidelines provided by the Treasury Department, Internal Revenue Service (IRS), and Department of Health and Human Services (HHS) (referred to as “the agencies”). Details on those guidelines can be found on the IRS’s website at the following link: https://www.irs.gov/newsroom/irs-expands-list-of-preventive-care-for-hsa-participants-to-include-certain- care-for-chronic-conditions The agencies will periodically review the list of preventive care services and items to determine whether additional services or items should be added or if any should be removed from the list. You will be notified if updates are incorporated into your Plan. Please refer to the Schedule of Benefits for further details on how benefits will be paid. Prosthetics Please see “Durable Medical Equipment (DME), Medical Devices, and Supplies” earlier in this section. Pulmonary Therapy Please see “Therapy Services” later in this section. Radiation Therapy Please see “Therapy Services” later in this section. Rehabilitation Services Benefits include services in a Hospital, free-standing Facility, Skilled Nursing Facility, or in an outpatient day rehabilitation program. Covered Services involve a coordinated team approach and several types of treatment, including skilled nursing care, physical, occupational, and speech therapy, and services of a social worker or psychologist. To be Covered Services, rehabilitation services must involve goals you can reach in a reasonable period of time. Benefits will end when treatment is no longer Medically Necessary and you stop progressing toward those goals. Respiratory Therapy Please see “Therapy Services” later in this section. Skilled Nursing Facility When you require Inpatient skilled nursing and related services for convalescent and rehabilitative care, Covered Services are available if the Facility is licensed or certified under state law as a Skilled Nursing Facility. Custodial Care is not a Covered Service.
Anthem Blue Access PPO Option 23 with Rx Option T3 IN PPO Large 96R4 01 01 2025 L12026M001 L12026 English EOC CY Page 56 Page 58