50 The Maximum Allowed Amount for Emergency Care from an Out - of - Network Provider will be determined using the median Plan In - Network contract rate we pay In - Network Providers for the geographic area where the service is provided for the same or similar services . If you are admitted to the Hospital from the Emergency Room, be sure that you or your Doctor calls us as soon as you are stabilized. We will review your care to decide if a Hospital stay is needed and how many days you should stay. See Getting Approval for Benefits for more details Treatment you get after your condition has stabilized is not Emergency Care. Please refer to the Consolidated Appropriations Act of 2021 Notice at the front of this Booklet for more details on how this will impact your benefits. Habilitative Services Benefits also include habilitative health care services and devices that help you keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isnt walking or talking at the expected age. These services may incl ude physical and occupational therapy, speech - language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings. Please see Therapy Services later in this section for further details. Home Health Care Services Benefits are available for Covered Services performed by a Home Health Care Agency or other Provider in your home. To be eligible for benefits, you must essentially be confined to the home, as an alternative to a Hospital stay, and be physically unable to get needed medical services on an outpatient basis. Services must be prescribed by a Doctor and the services must be so inherently complex that they can be safely and effectively performed only by qualified, technical, or professional health staff. Covered Services include but are not limited to: Intermittent skilled nursing services by an R.N. or L.P.N. Medical / social services Diagnostic services Nutritional guidance Training of the patient and/or family/caregiver Home health aide services. You must be receiving skilled nursing or therapy. Services must be given by appropriately trained staff working for the Home Health Care Provider. Other organizations may give services only when approved by us, and their duties must be assigned and supervised by a professional nurse on the staff of the Home Health Care Provider or other Provider as approved by the Plan. Therapy Services (except for Manipulation Therapy, which will not be covered when given in the home) Medical supplies Durable medical equipment Private duty nursing services When available in your area, benefits are also available for Intensive In - home Behavioral Health Services. These do not require confinement to the home. These services are described in the Mental Health and Substance Use Disorder Services section below. Benefits may also be available for Inpatient Services in your home. These benefits are separate from the Home Health Care Services benefit, and are described in the Inpatient Services section below.