2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Page 79
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Page 79
Benefit Description
Hospice Care (cont.)
Traditional Home Hospice Care*
Periodic visits to the member’s home for the management of the terminal medical condition and to provide limited patient care in the home. An episode of care is one home hospice treatment plan per calendar year. See page 20 for prior approval requirements.
*Prior approval is required
You Pay
Preferred facilities: Nothing (no deductible)
Non-preferred facilities (Member/Non-member): You pay all charges
Hospice Care (cont.)
Traditional Home Hospice Care*
Periodic visits to the member’s home for the management of the terminal medical condition and to provide limited patient care in the home. An episode of care is one home hospice treatment plan per calendar year. See page 20 for prior approval requirements.
*Prior approval is required
You Pay
Preferred facilities: Nothing (no deductible)
Non-preferred facilities (Member/Non-member): You pay all charges
Benefit Description
Continuous Home Hospice Care*
Services provided in the home to members enrolled in home hospice during a period of crisis, such as frequent medication adjustments to control symptoms or to manage a significant change in the member’s condition, requiring a minimum of 8 hours of care during each 24-hour period by a registered nurse (R.N.) or licensed practical nurse (L.P.N.).
Note: Members must receive prior approval from the Local Plan for each episode of continuous home hospice care (see page 20). An episode consists of up to seven consecutive days of continuous care. The member must be enrolled in a home hospice program in order to receive benefits for subsequent continuous home hospice care and the services must be provided by the home hospice program in which the member is enrolled.
*Prior approval is required
You Pay
Preferred facilities: Nothing (no deductible)
Non-preferred facilities (Member/Non-member): You pay all charges
Continuous Home Hospice Care*
Services provided in the home to members enrolled in home hospice during a period of crisis, such as frequent medication adjustments to control symptoms or to manage a significant change in the member’s condition, requiring a minimum of 8 hours of care during each 24-hour period by a registered nurse (R.N.) or licensed practical nurse (L.P.N.).
Note: Members must receive prior approval from the Local Plan for each episode of continuous home hospice care (see page 20). An episode consists of up to seven consecutive days of continuous care. The member must be enrolled in a home hospice program in order to receive benefits for subsequent continuous home hospice care and the services must be provided by the home hospice program in which the member is enrolled.
*Prior approval is required
You Pay
Preferred facilities: Nothing (no deductible)
Non-preferred facilities (Member/Non-member): You pay all charges
Benefit Description
Inpatient Hospice Care*
Benefits are available for inpatient hospice care when provided by a facility that is licensed as an inpatient hospice facility and when:
Note: Benefits are provided for up to 30 consecutive days in a facility licensed as an inpatient hospice facility. The member does not have to be enrolled in a home hospice care program to be eligible for the first inpatient stay. However, the member must be enrolled in a home hospice care program in order to receive benefits for subsequent inpatient stays.
*Prior approval is required
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred facilities (Member/Non-member): You pay all charges
Inpatient Hospice Care*
Benefits are available for inpatient hospice care when provided by a facility that is licensed as an inpatient hospice facility and when:
- Inpatient services are necessary to control pain and/or manage the member’s symptoms;
- Death is imminent; or
- Inpatient services are necessary to provide an interval of relief (respite) to the caregiver
Note: Benefits are provided for up to 30 consecutive days in a facility licensed as an inpatient hospice facility. The member does not have to be enrolled in a home hospice care program to be eligible for the first inpatient stay. However, the member must be enrolled in a home hospice care program in order to receive benefits for subsequent inpatient stays.
*Prior approval is required
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred facilities (Member/Non-member): You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page 78)
- Homemaker services
- Home hospice care (e.g., care given by a home health aide) that is provided and billed for by other than the approved home hospice agency when the same type of care is already being provided by the home hospice agency
You Pay
All charges