Ohio Essential Health Benefits Benchmark Plan Template Page 1 of 7
Ohio Essential Health Benefits Benchmark Plan Template Page 1 of 7
Ohio Essential Health Benefits Benchmark Plan Template Page 1 of 7
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<strong>Ohio</strong> <strong>Essential</strong> <strong>Health</strong> <strong>Benefits</strong> Resource Document for 2015 <strong>Plan</strong> Year<strong>Benefits</strong> Covered? Benefit DescriptionQuantitativeLimit onService?LimitQuantityLimit Units"Other" LimitUnits DescriptionMinimumStayExclusionsAdditional ExplanationDoes this benefit haveadditional limitations orrestrictions?Long-Term/Custodial NursingHome CareNot CoveredLong-Term/CustodialNursing Home CarePrivate-DutyNursingCoveredPrivate duty nursingservicesYes 90 - 110* Visits peryearPrivate duty nursing services in an inpatientsetting.Home nursing services provided through home health care. Limitapplies to Private duty nursing in home setting.*Quantitative Limitrepresents number <strong>of</strong> visitsto meet establishedactuarial equivalent <strong>of</strong>benchmark plan annualdollar limits.Annual and lifetime $ limitswill no longer apply.Routine Eye Exam(Adult)Not Covered Routine Eye Exam Routine eye exam and refraction are not covered, as well as services for visiontraining and orthoptics, eyeglasses and eyewear.Urgent CareCenters orFacilitiesHome <strong>Health</strong> CareServicesCoveredUrgent Care Services in anUrgent Care Center orFacilityCovered Home <strong>Health</strong> Care Services Yes 100 Visits peryearNoFood, housing, homemaker services and home delivered meals; home oroutpatient hemodialysis services; physician charges; helpful environmentalmaterials; Services provided by registered nurses and other health workerswho are not acting as employees or under approved arrangements with acontracting Home <strong>Health</strong> Care Provider; Services provided by a member <strong>of</strong> thepatient's immediate family; Services provided by volunteer ambulanceassociations for which patient is not obligated to pay, visiting teachers,vocational guidance and other counselors, and services related to outside,occupational and social activities; Manipulation therapy services rendered inthe home.Medical treatment provided in the home on a part time orintermittent basis including visits by a licensed health carepr<strong>of</strong>essional, including a nurse, therapist, or home health aide; andphysical, speech, and occupational therapy. When these therapyservices are provided as part <strong>of</strong> home health they are not subject toseparate visit limits for therapy services. 100 visit/year limit notapplicable to home infusion therapy or private duty nursing renderin home setting.NoNoEmergency RoomServicesCovered Emergency Room Services No Care received in and emergency room that is not emergency care. NoEmergencyTransportation/AmbulanceCoveredEmergency Transportation/AmbulanceNoNon covered services for ambulance include but are not limited to, trips to aphysician's <strong>of</strong>fice or clinic, a morgue or a funeral home.Ambulance transportation from home, scene <strong>of</strong> accident or medicalemergency to hospital; between hospitals; between hospital andskilled nursing facility; from hospital or skilled nursing facility topatient's home.No<strong>Page</strong> 2 <strong>of</strong> 12
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