2026 CODAC Benefit Summaries and Carrier Flyers

33. Habilitative Services . Benefits are provided for habilitative services provided on an outpatient basis for Covered Persons with a congenital, genetic, or early acquired disorder when both of the following conditions are met: The treatment is administered by a licensed speech-language pathologist, licensed audiologist, licensed occupational therapist, licensed physical therapist, Physician, licensed nutritionist, licensed social worker or licensed psychologist. The initial or continued treatment must be proven and not Experimental or Investigational. Benefits for habilitative services do not apply to those services that are solely educational in nature or otherwise paid under state or federal law for purely educational services. Custodial Care, respite care, day care, therapeutic recreation, vocational training and residential treatment are not habilitative services. A service that does not help the Covered Person to meet functional goals in a treatment plan within a prescribed time frame is not a habilitative service. When the Covered Person reaches his/her maximum level of improvement or does not demonstrate continued progress under a treatment plan, a service that was previously habilitative is no longer habilitative.

34.

Hearing Services include:

• Exams, tests, services, and supplies to diagnose and treat a medical condition. • Purchase or fitting of hearing aids. • Implantable hearing devices, including semi-implantable hearing devices.

35. Home Health Care Services: (Refer to Home Health Care section of this SPD.)

36. Hospice Care Services: Treatment given at a Hospice Care Facility must be in place of a stay in a Hospital or Extended Care Facility, and may include:

• Assessment, which includes an assessment of the medical and social needs of the Terminally Ill person and a description of the care required to meet those needs. • Inpatient Care in a facility when needed for pain control and other acute and chronic symptom management, psychological and dietary counseling, physical or occupational therapy, and part time Home Health Care services. • Outpatient Care, which provides or arranges for other services related to the Terminal Illness, including the services of a Physician or Qualified physical or occupational therapist or nutrition counseling services provided by or under the supervision of a Qualified dietician. • Respite Care to provide temporary relief for to the family or other caregivers in the case of an Emergency or to provide temporary relief from the daily demands of caring for a terminally ill person. • Bereavement Counseling: services that are received by a Covered Person’s Close Relative when directly connected to the Covered Person’s death and the charges for which are bundled with other hospice charges. Counseling services must be provided by a Qualified social worker, Qualified pastoral counselor, Qualified psychologist, Qualified psychiatrist, or other Qualified Provider, if applicable. The Covered Person must be Terminally Ill with an anticipated life expectancy of about six months. However, services are not limited to a maximum of six months if continued Hospice Care is deemed appropriate by the Physician, up to the maximum hospice benefits available under the Plan.

37. Hospital Services (Including Inpatient Services, Surgical Centers, And Inpatient Birthing Centers). The following services are covered:

• Semi-private and private room and board services: ➢

For network charges, this rate is based on the network agreement. Semi-private rate reductions may apply.

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