2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 55
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(26) Hospice Care: Hospice care on either an inpatient or outpatient basis for a terminally ill person rendered
under a Hospice treatment plan. The Hospice treatment plan must certify that the person is terminally ill with
a life expectancy of 6 months or less.
Covered services include:
(a)
Room and board charges by the Hospice.
(b)
Other Medically Necessary services and supplies.
(c)
Nursing care by or under the supervision of a registered nurse (R.N.).
(d)
Home health care services furnished in the patient's home by a Home Health Care Agency for the
following:
(i)
health aide services consisting primarily of caring for the patient (excluding housekeeping,
meals, etc.); and
(ii)
physical and speech therapy.
(e)
Counseling services by a licensed social worker or a licensed pastoral counselor for the patient's
immediate family.
(f)
Bereavement counseling services by a licensed social worker or a licensed pastoral counselor for the
patient's immediate family within 12 months after the patient's death. For the purposes of bereavement
counseling, the term "Patient's Immediate Family" means the patient's Spouse, parents, and/or
Dependent children who are covered under the Medical Plan.
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(27) Hospital Services or Long-Term Acute Care Facility/Hospital:
(a)
Inpatient
Room and board, including all regular daily services in a Hospital or Long-Term Acute Care
Facility/Hospital. Care provided in an Intensive Care Unit (including cardiac care (CCU) and burn units).
Miscellaneous services and supplies, including any additional Medically Necessary nursing services
furnished while being treated on an inpatient basis.
(b)
Outpatient
Services and supplies furnished while being treated on an outpatient basis. Eligible expenses will be
payable as shown in the Medical Schedule of Benefits.
(28)
Injectables: Expenses Incurred by an Employee or a Dependent for injectable medicines, such as human
growth hormone injections, that are Medically Necessary for the treatment of a covered Illness or injury that
is administered by a Physician, under the supervision of a Physician or registered nurse, are otherwise
considered eligible in accordance with the Medical Schedule of Benefits and are not otherwise excluded
under the General Limitations and Exclusions section of the Group Medical Plan, will be payable subject to
any applicable Deductible and Coinsurance.
(29) Maternity: Expenses Incurred by an Employee or a Dependent Spouse for:
(a)
Pregnancy.
(b)
Services provided by a Birthing Center.
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