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Inpatient and outpatient services not covered by Medicare, when the services are furnished by an HMO Blue Physician, Psychologist or other HMO Blue Mental Health Provider, including a Licensed Independent Clinical Social Worker or by a Clinical Specialist in Psychiatric and Mental Health Nursing, Licensed Mental Health Counselor or Licensed Alcohol and Drug Counselor to treat biologically-based mental conditions and to treat rape-related mental or emotional disorders for victims of a rape or victims of an assault with intent to rape. This coverage is provided for as many days/visits as are medically necessary.

Treatment of autism spectrum disorders. This includes (but not limited to): habilitative and rehabilitative care to develop, maintain and restore (to the maximum extent practicable) the functioning of the member; and applied behavior analysis (ABA) furnished by a Board Certified Behavior Analyst who is employed by an HMO Blue facility or agency or who has been designated and approved for coverage by Medex Choice. (Effective October 1, 2016, ABA services are also covered when furnished or supervised by a psychologist or a licensed applied behavioral analyst.)

Medex Choice covers services to diagnose or treat mental conditions when the services are furnished by an HMO Blue Hospital, Physician, Psychologist or other HMO Blue Mental Health Provider. This coverage includes:

Medicare-approved inpatient hospital services in an HMO Blue Hospital, including a Mental Hospital, for 90 days in a benefit period. (But, Medicare days in a Mental Hospital are limited to a 190-day lifetime maximum.) 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. After Medicare Part A benefits have run out, Medex Choice provides full coverage for an additional 365 days for approved inpatient hospital services in an HMO Blue General, Chronic Disease, and Rehabilitation Hospital. This is a lifetime benefit limit. The Medicare lifetime reserve days must be used before Medex Choice will provide benefits for these additional benefit days.

Medicare-approved inpatient and outpatient services when the services are furnished by an HMO Blue Physician, Psychologist or other HMO Blue Mental Health Provider. This coverage is provided for as many days/visits as are medically necessary.

Inpatient Mental Hospital services not covered by Medicare for 60 days each calendar year, or for members with a Choice PCP, 120 days in a benefit period (but at least 60 days each calendar year), when the admission is furnished in an HMO Blue Mental Hospital. (This day limit may be reduced by any days already paid for inpatient Mental Hospital services. Refer to the policy for more information.)

Outpatient services not covered by Medicare, when the services are furnished by an HMO Blue Physician, Psychologist or other HMO Blue Mental Health Provider, including a Licensed Independent Clinical Social Worker or by a Clinical Specialist in Psychiatric and Mental Health Nursing, Licensed Mental Health Counselor or Licensed Alcohol and Drug Counselor for 24 visits each calendar year.

For many preventive health services, Medicare provides full benefits. Medex Choice covers Medicare-approved services (that are not covered in full by Medicare) when the services are furnished by an HMO Blue provider. Some examples of covered preventive services include:

A one-time Welcome to Medicare preventive visit.

An annual wellness visit to discuss preventive care for the coming year.