Search

Note: The combined benefits for durable medical equipment, prosthetic devices and oxygen (including equipment for its administration) count toward the $5,000 benefit limit that will determine the member's coinsurance each calendar year.

Note: The combined benefits for durable medical equipment, prosthetic devices and oxygen (including equipment for its administration) count toward the $5,000 benefit limit that will determine the member's coinsurance each calendar year.

A benefit period starts on the first day (that is not part of a prior benefit period) on which the member receives covered inpatient services in a hospital or skilled nursing facility. It ends when the member has gone 60 days without being an inpatient in a hospital, skilled nursing facility or similar facility.

A benefit period starts on the first day (that is not part of a prior benefit period) on which the member receives covered inpatient services in a hospital or skilled nursing facility. It ends when the member has gone 60 days without being an inpatient in a hospital, skilled nursing facility or similar facility.

A benefit period starts on the first day (that is not part of a prior benefit period) on which the member receives covered inpatient services in a Chronic Disease or Rehabilitation Hospital or Skilled Nursing Facility. It ends when the member has gone 60 days without being an inpatient in a similar facility.

A benefit period starts on the first day (that is not part of a prior benefit period) on which the member receives covered inpatient services in a Chronic Disease or Rehabilitation Hospital or Skilled Nursing Facility. It ends when the member has gone 60 days without being an inpatient in a similar facility.

A benefit period starts on the first day (that is not part of a prior benefit period) on which the member receives covered inpatient services in a Chronic Disease or Rehabilitation Hospital or Skilled Nursing Facility. It ends when the member has gone 60 days without being an inpatient in a similar facility.

One routine visit every two calendar years for a member age 19 or older. This includes: history and risk assessment; chest x-ray; EKG, urinalysis; basic and comprehensive metabolic panel; complete blood count; fecal occult blood test; prostate-specific antigen blood test; chlamydial infection test; and fasting lipoprotein profile.

Tetanus-diphtheria booster once every ten years.

Routine immunizations (including hepatitis A and B for members with increased risk or family history, flu shots, pneumococcal vaccine and Lyme disease booster) once every two calendar years.