CALIFORNIA - Pacificare Health Systems

Hospice
Hospice care provides palliative service. It is
based on the philosophy that everyone has
the right to spend his or her remaining days
in peace and with dignity. Hospice focuses on
comfort, dignity and pain control, responding
to the symptoms, needs and goals of patients
and families. Hospice is dedicated to helping
the terminally ill live each day to the fullest
throughout the dying process, and supporting
them to be with their family and friends in a
home setting if they wish.
Hospice care is not a Secure Horizons
Group Retiree Medicare Advantage Plan
Covered Service. However, PacifiCare
will cover one (1) Hospice evaluation for
Members who have not yet chosen Hospice
care to determine if Hospice care is an
appropriate health care option.
In order to access Hospice care, Members
must elect Hospice care under Medicare.
Upon making this election, all care related to
the terminal illness will be provided by the
Medicare-certified Hospice which is billed
directly to Medicare. Any other Medicarecovered
services that are not related to
the terminal illness will also be billed to
Medicare. You may remain enrolled in the
Secure Horizons Group Retiree Medicare
Advantage Plan even if you elect Medicarecertified
Hospice coverage for your terminal
condition. PacifiCare will continue to arrange
coverage of non-Medicare-covered benefits,
which are not related to your Medicare
Hospice benefits.
As a Secure Horizons Group Retiree Medicare
Advantage Plan Member, you have the right
to obtain information about all available
Medicare-certified Hospice Providers. For
more information regarding electing Hospice
care, including those Hospice facilities that
have an agreement with your Contracting
Medical Group/IPA, please contact Customer
Service.
Section 5 – Working With Your
Contracting Medical Providers
Clinical Trials and Other Medicare
Benefits
If you participate as a patient in a clinical
trial that meets Medicare requirements,
Medicare covers routine costs of qualifying
clinical trials. Clinical trials are not a Secure
Horizons Medicare Advantage Plan Covered
Service. If you join a clinical trial, you will
be responsible for any Coinsurance under
Medicare.
When you enroll in a clinical trial, the
providers are paid directly by Medicare for all
the Covered Services you receive. The clinical
trial providers do not have to be Contracting
Medical Providers.
This means you do not need to obtain a
Referral to join a clinical trial. However, you
should inform PacifiCare before you begin
a clinical trial. This allows PacifiCare to
continue to keep track of your health care
services. You may remain enrolled in Secure
Horizons Medicare Advantage Plan even if you
elect to participate in a clinical trial. Your care
unrelated to the clinical trial must continue
to be arranged by PacifiCare. The Medicare
program has written a booklet about
Medicare and Clinical Trials. To get a free
copy, call 1-800-MEDICARE (1-800-633-4227)
or visit www.medicare.gov on the Web.
Religious Nonmedical Health Care
Institutions (RNHCIs) Care
Care in a Medicare-certified Religious
Nonmedical Health Care Institution (RNHCI)
is covered by PacifiCare under certain
conditions. Covered Services in a RNHCI are
limited to nonreligious aspects of care. To
be eligible for Covered Services in a RNHCI,
you must have a medical condition that
would allow you to receive inpatient Hospital
care or extended care services or care in a
Home Health agency. You may get services
when furnished in the home, but only items
and services ordinarily furnished by Home
Health agencies that are not RNHCIs. In
addition, you must sign a legal document
that says you are conscientiously opposed
Questions? Call the Customer Service Department at 1-800-228-2144,
(TDHI) 1-800-685-9355, Monday through Friday, 7:00 a.m. to 9:00 p.m.
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PART B