2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 58
(b)
Outpatient Nursing Care. Charges are covered only when care is Medically Necessary and not
Custodial in nature. Charges covered for outpatient nursing care billed by a Home Health Care Agency
are shown under Home Health Care Services and Supplies. Outpatient private duty nursing care not
billed by a Home Health Care Agency must be supported by a certification and a treatment plan from
the attending Physician.
(42) Prosthetic Devices: Artificial limbs, eyes or other prosthetic devices when necessary due to an Illness or
Injury. This benefit includes any necessary repairs to restore the prosthesis to a serviceable condition. If such
prosthesis cannot be restored to a serviceable condition, replacement will be considered eligible, subject to
prior approval by the Medical Plan. In all cases, repairs or replacement due to abuse or misuse, as determined
by the Medical Plan, are not covered.
(43) Pulmonary Therapy: Pulmonary therapy under the recommendation of a Physician.
(44) Radiation Therapy: Radium and radioactive isotope therapy treatment. Precertification is required for
radiation therapy, see the Medical Management section for further details.
(45) Reconstructive Surgery: See Cosmetic Procedures/Reconstructive Surgery.
(46) Rehabilitation Facility: Inpatient care in a Rehabilitation 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
Extended Care Facility confinement; and (c) is not for Custodial Care.
See the Extended Care Facility benefit for services and supplies provided for confinements in an Extended
Care Facility.
Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
(47) Routine Cancer Screening (POS Provider only): The following routine cancer screening procedures (as
outlined by the American Cancer Society) will be payable as shown in the Medical Schedule of Benefits:
Colon and Rectal Exams
Beginning at age 45, both men and women are eligible for these 5 testing schedules:
(a)
Yearly fecal occult blood test (FOBT).
(b)
Flexible sigmoidoscopy every 5 years.
(c)
Yearly fecal occult blood test plus flexible sigmoidoscopy every 5 years.
(d)
Double-contrast barium enema every 5 years.
(e)
Colonoscopy every 5 years and secondary follow up colonoscopy when required by a Physician.
Cervical Cancer
(a) Beginning at age 21, annual screenings are eligible every year with the regular Pap test or every 2
years with the new liquid-based Pap test.
(b)
Beginning at age 30, women who have had three normal Pap test results in a row may get screened
every 2 to 3 years with either the convention (regular) or liquid-based Pap test. Women who have
certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened
immune system due to organ transplant, chemotherapy, or chronic steroid use may continue to be
screened annually.
(c)
Women over 30 may also be screened every 3 years (but not more frequently) with the convention or
liquid-based Pap test, plus the HPV DNA test.
Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal
(d)
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