2026 CODAC Benefit Summaries and Carrier Flyers

Monitoring Hospital or skilled nursing facility.

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Assistance obtaining any necessary equipment and services.

Case Management is a voluntary service however, participation is recommended. There are no reductions of benefits or penalties if the patient chooses not to participate.

ALTERNATIVE TREATMENT PLAN UNDER CASE MANAGEMENT

In the course of the Case Management program, the Plan Administrator shall have the right to alter or waive the normal provisions of this Plan of benefits when it is reasonable to expect a cost-effective result without a sacrifice to the quality of patient care. Alternative care will be determined on the merits of each individual case and only when and for so long as it determines that alternative services are Medically Necessary and cost-effective.

An alternative treatment plan should meet the following criteria:

• The treatment must be medically indicated and necessary for the condition being treated. • The treatment must not be Experimental, Investigational, or Unproven. • The treatment must be cost-effective to both the member and the Plan. • The treatment must be provided as an alternative to an otherwise covered expense under the Plan. If the Plan elects to provide alternative benefits for a Covered Person in one instance, it will not be considered as setting any precedent and shall not be obligated to provide the same or similar benefits for other Covered Persons under this Plan in any other instance, nor shall it be construed as a waiver of the right to administer this Plan thereafter in strict accordance with its express terms.

Nothing contained in this Plan of benefits shall obligate the Plan Administrator to approve an alternative treatment plan.

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