Huntington Ingalls Newport News Anthem Key ... - Benefits Connect

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20 - What is covered • services of a medical social worker; • services of a home health aide or homemaker; • short-term inpatient care, including both respite care and procedures necessary for pain control and acute chronic symptom management. Respite care means non-acute inpatient care for the covered person in order to provide the covered person’s primary caregiver a temporary break from caregiving responsibilities. Respite care may be provided only on an intermittent, non-routine and occasional basis and may not be provided for more than five days every 90 days; • physical, speech, or occupational therapy (services provided as part of hospice care are not subject to dollar-limits); • medical equipment (durable); • routine medical supplies; • routine lab services; • counseling, including nutritional counseling with respect to the covered person’s care and death; and • bereavement counseling for immediate family members both before and after the covered person’s death. Hospital services Your health plan covers the hospital and doctors’ services when you are treated on an outpatient basis, or when you are an inpatient because of illness, injury, or pregnancy. (See Maternity on page 21 for an additional discussion of pregnancy benefits.) Your health plan covers medically necessary care in a semi-private room or intensive or special care unit. This includes your bed, meals, special diets, and general nursing services. In addition to your semi-private room, general nursing services and meals, your health plan covers the maximum allowed amount for medically necessary services and supplies furnished by the hospital when prescribed by your doctor or provider. The hospital must meet the American Hospital Association’s standards for registration as a hospital. Remember that your share of the cost of covered services will change if you use a doctor, facility, or other health care provider that is outside your network. While you are an inpatient in the hospital, your health plan covers the medically necessary services rendered by doctors and other covered providers. Helpful tip: All non-emergency inpatient hospital stays must be approved in advance, except hospital stays for vaginal or cesarean deliveries without complications. Private room Your health plan will cover the private room charge if you need a private room because you have a highly contagious condition or are at greater risk of contracting an infectious disease because of your medical condition. Otherwise, your inpatient benefits would cover the hospital’s charges for a
What is covered - 21 semi-private room. If you choose to occupy a private room, you will be responsible for paying the daily differences between the semi-private and private room rates in addition to your copayment and coinsurance (if any). Infusion services Your health plan covers infusion therapy, which is treatment by placing therapeutic agents into the vein, and parenteral administration of medication and nutrients. Infusion services also include enteral nutrition, which is the delivery of nutrients by tube into the gastrointestinal tract. These services include coverage of all medications administered intravenously and/or parenterally. Helpful tip: Infusion services may be received at multiple sites of service, including facilities, professional provider offices, ambulatory infusion centers and from home infusion providers. <strong>Benefits</strong> may vary by place of service, and where you choose to receive covered services may result in a difference in your copayment and/or coinsurance. Please see the Infusion services section on the Summary of benefits for a description of the benefits by place of service. Maternity Prenatal and newborn care If you (or your covered spouse) become pregnant, your health plan provides several coverage features. Maternity care, maternity-related checkups, and delivery of the baby in the hospital are covered by your health plan. Helpful tip: See Eligibility for coverage on page 55 for details on when and how to enroll a newborn. Your benefits include: • use of the delivery room and care for normal deliveries; • home setting covered with nurse midwives; • anesthesia services to provide partial or complete loss of sensation before delivery; • hospital services for routine nursery care for the newborn during the mother’s normal hospital stay; • prenatal and postnatal care services for pregnancy and complications of pregnancy for which hospitalization is necessary; • initial examination of a newborn and circumcision of a covered male dependent; • services for interruption of pregnancy; and • fetal screenings, which are tests for the genetic and/or chromosomal status of the fetus. The term also means anatomical, biochemical or biophysical tests, to better define the likelihood of genetic and/or chromosomal anomalies.
Page 1 and 2: Huntington Ingalls Industries, Inc.
Page 3 and 4: SUMMARY PLAN DESCRIPTION KEYCARE 15
Page 5 and 6: SECTION I - MEMBER CERTIFICATE This
Page 7: STEELWORKERS HEALTH AND WELFARE FUN
Page 10 and 11: Helpful tip: Look for these icons t
Page 12 and 13: Index. . . . . . . . . . . . . . .
Page 14 and 15: 2 - Summary of benefits In-network
Page 16 and 17: 4 - Summary of benefits In-network
Page 18 and 19: 6 How your health plan works Your h
Page 20 and 21: 8 - How your health plan works Choo
Page 22 and 23: 10 - How your health plan works All
Page 24 and 25: 12 - How your health plan works Bef
Page 26 and 27: 14 - How your health plan works •
Page 28 and 29: 16 What is covered Your health plan
Page 30 and 31: 18 - What is covered • nuclear ca
Page 34 and 35: 22 - What is covered If your doctor
Page 36 and 37: 24 - What is covered How your healt
Page 38 and 39: 26 - What is covered We have establ
Page 40 and 41: 28 - What is covered Services of no
Page 42 and 43: 30 - What is covered Morbid obesity
Page 44 and 45: 32 - What is covered Physical thera
Page 46 and 47: 34 - What is covered Your health pl
Page 48 and 49: 36 - What is not covered This exclu
Page 50 and 51: 38 - What is not covered However, i
Page 52 and 53: 40 - What is not covered Your cover
Page 54 and 55: 42 - What is not covered W Your cov
Page 56 and 57: 44 - Claims and payments Out-of-net
Page 58 and 59: 46 - Claims and payments Providers
Page 60 and 61: 48 - Claims and payments • the ou
Page 62 and 63: 50 - Claims and payments In additio
Page 64 and 65: 52 When you are covered by more tha
Page 66 and 67: 54 - When you are covered by more t
Page 68 and 69: 56 - Eligibility for coverage Chang
Page 70 and 71: 58 - Eligibility for coverage will
Page 72 and 73: 60 - Eligibility for coverage Depen
Page 74 and 75: 62 - Eligibility for coverage Conti
Page 76 and 77: 64 - Eligibility for coverage When
Page 78 and 79: 66 - Eligibility for coverage A qua
Page 80 and 81: 68 - Important information about yo
Page 82 and 83:
70 - Important information about yo
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
76 - Member’s rights and responsi
Page 90 and 91:
78 - Definitions Emergency services
Page 92 and 93:
80 - Definitions Out-of-network is
Page 94 and 95:
82 - Definitions Skilled nursing fa
Page 96 and 97:
84 - Exhibit A Clinical trial costs
Page 98 and 99:
86 page Newborn . . . . . . . . . .
Page 100 and 101:
88 - Special features and programs
Page 102:
Anthem Blue Cross and Blue Shield 2
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Huntington Ingalls Newport News Anthem Key ... - Benefits Connect

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