2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 54
Medical Plan, are not covered; and
(f)
Expenses for the rental or purchase of any type of air conditioner, air purifier or any other device or
appliance will not be considered eligible.
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(20) Emergency Room Services: Treatment in a Hospital emergency room, including professional services.
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(21) Extended Care Facility: Extended convalescent care provided in an Extended Care Facility, provided such
confinement: (a) is under the recommendation and general supervision of a Physician; (b) is for the purpose
of receiving medical care necessary for convalescence from the conditions causing or contributing to the
precedent Hospital or Rehabilitation Facility confinement; and (c) is not for Custodial Care.
See the Rehabilitation Facility benefit for services and supplies provided for confinements in a Rehabilitation
Facility.
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(22) Genetic Testing: Diagnostic testing of Genetic Information, counseling and BRAC testing deemed Medically
Necessary. Genetic testing is covered in addition to and to the extent it is not otherwise included for coverage
under the preventive services section of the Plan.
Eligible expenses will be payment as show in the Medical Schedule of Benefits.
(23) Hearing Aids: Hearing aids, required for the correction of a hearing impairment, as prescribed by a Physician
or Audiologist. A hearing aid consists of a microphone, amplifier, and receiver. Eligible expenses will be
payable as shown in the Medical Schedule of Benefits.
(24) Hemodialysis/Peritoneal Dialysis: Treatment of a kidney disorder by hemodialysis or peritoneal dialysis as
an inpatient in a Hospital or other facility or for expenses in an outpatient facility or in the Covered Person’s
home, including the training of one attendant to perform kidney dialysis at home. The attendant may be a
family member, but will not be eligible for payment. When home care replaces inpatient or outpatient dialysis
treatments, the Medical Plan will pay for rental of dialysis equipment and expendable medical supplies for use
in the Covered Person’s home as shown under the Durable Medical Equipment benefit.
(25) Home Health Care: Services provided by a Home Health Care Agency to a Covered Person in the home.
The following are considered eligible home health care services:
(a)
Home nursing care;
(b)
Services of a home health aide or licensed practical nurse (L.P.N.), under the supervision of a
registered nurse (R. N.);
(c)
Physical, occupational, speech, or respiratory therapy if provided by the Home Health Care Agency;
(d)
Medical supplies, drugs and medications prescribed by a Physician;
(e)
Laboratory services; and
(f)
Nutritional counseling by a licensed dietician.
For the purpose of determining the benefits for home health care available to a Covered Person, each visit by
a member of a Home Health Care Agency shall be considered as one home health care visit and each 4 hours
of home health aide services shall be considered as one home health care visit.
In no event will the services of a Close Relative, social worker, transportation services, housekeeping services
and meals, etc., be considered an eligible expense.
50