For a Skilled Nursing Facility that does not participate with Medicare, Medex pays $8 each day from day 1 to day 365 in the benefit period. The member pays all charges that are more than $8 a day.
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.
(The 365 Medex days per benefit period is a combined benefit limit for admissions in a Medicare Skilled Nursing Facility and a non-Medicare Skilled Nursing Facility.)
This Medex plan covers Medicare-approved inpatient services furnished by a Physician or other Medicare covered professional provider, including a Podiatrist, Certified Registered Nurse Anesthetist, Nurse Midwife and Nurse Practitioner. These benefits are provided for as many days as are medically necessary for the member's condition.
Physicians' services for stem cell (bone marrow") transplants for breast cancer. This includes harvesting of the donor's stem cells when the recipient is a member and drug therapy during the transplant procedure to prevent rejection of the transplanted stem cells."