Noblesville Schools Medical Plan 46 Section 1: Covered Health Care Services • A service or treatment plan that does not help you meet functional goals. • Services solely educational in nature. • Educational services otherwise paid under state or federal law. The Claims Administrator may require the following be provided: • Medical records. • Other necessary data to allow the Claims Administrator to prove that medical treatment is needed. When the treating provider expects that continued treatment is or will be required to allow you to achieve progress the Claims Administrator may request additional medical records. • Frequency of treatment plan updates. Habilitative services provided in your home by a Home Health Agency are provided as described under Home Health Care. Habilitative services provided in your home other than by a Home Health Agency are provided as described under this section. Benefits for DME and prosthetic devices, when used as a part of habilitative services, are described under Durable Medical Equipment (DME), Orthotics and Supplies and Prosthetic Devices. Home Health Care Services received from a Home Health Agency that are all of the following: • Ordered by a Physician. • Provided in your home by a registered nurse, or provided by either a home health aide or licensed practical nurse and supervised by a registered nurse. • Provided on a part-time, Intermittent Care schedule. • Provided when Skilled Care is required. The Claims Administrator will determine if Benefits are available by reviewing both the skilled nature of the service and the need for Physician-directed medical management. Hospice Care Hospice care that is recommended by a Physician. Hospice care is an integrated program that provides comfort and support services for the terminally ill. It includes the following: • Physical, psychological, social, spiritual and respite care for the terminally ill person. • Short-term grief counseling for immediate family members while you are receiving hospice care. Benefits are available when you receive hospice care from a licensed hospice agency. You can call the Claims Administrator at the telephone number on your ID card for information about the Claims Administrator's guidelines for hospice care. Hospital - Inpatient Stay Services and supplies provided during an Inpatient Stay in a Hospital. Benefits are available for: • Supplies and non-Physician services received during the Inpatient Stay. • Room and board in a Semi-private Room (a room with two or more beds).