HOME HEALTH CARE BENEFITS Home Health Care services are provided for patients when Medically Necessary, as determined by the Utilization Review Organization. Prior authorization may be required before receiving services. Please refer to the UMR CARE section of this SPD for more details. Covered services may include: • Home visits instead of visits to the provider’s office that do not exceed the maximum allowable under this Plan. • Intermittent nurse services. Benefits are paid for only one nurse at any one time, not to exceed 4 hours per 24-hour period. • Nutrition counseling provided by or under the supervision of a Qualified dietician or other Qualified Provider, if applicable. • Physical, occupational, respiratory, and speech therapy provided by or under the supervision of a Qualified therapist or other Qualified Provider, if applicable. • Medical supplies, drugs, laboratory services, or medication prescribed by a Physician. A Home Health Care Visit is defined as a visit by a nurse providing intermittent nurse services (each visit includes up to a 4-hour consecutive visit in a 24-hour period if Medically Necessary) or a single visit by a Qualified therapist, Qualified dietician, or other Qualified Provider, if applicable. EXCLUSIONS In addition to the items listed in the General Exclusions section, benefits will NOT be provided for any of the following: • Homemaker or housekeeping services. • Supportive environment materials such as handrails, ramps, air conditioners, and telephones. • Services performed by family members or volunteer workers. • “Meals on Wheels” or similar food service. • Separate charges for records, reports, or transportation. • Expenses for the normal necessities of living, such as food, clothing, and household supplies. • Legal and financial counseling services, unless otherwise covered under this Plan. -71- 7670-00-413597