This health plan also covers outpatient private duty nursing furnished by a registered nurse (RN) when it is medically necessary for the member's condition and furnished for the treatment of an approved prolonged illness condition.
Note: The same benefits that would be provided for covered services furnished by a network provider are also provided when an enrolled student receives covered services at a school infirmary outside of Massachusetts.
Nicotine gum or nicotine patches (or other smoking cessation aids that require a prescription by law) when prescribed by a Physician. These benefits are limited to one 90-day supply for each member.
This health plan also covers medically necessary inpatient admissions in a participating nursing home. These admissions are subject to the same provisions that apply for admissions in a skilled nursing facility, except that benefits for room and board charges are limited to a maximum payment of $18 for each day.
Medex pays the Medicare Part A coinsurance from day 61 to day 90 in the benefit period (or the Part A coinsurance when Medicare lifetime reserve days are used).