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Flex 2002 News:
Coverage Added for Skilled Nursing Care
Currently, the 90/10, 80/20, POS and PPO medical options provide coverage
for care and services delivered in a hospital—as well as various alternative
care settings, such as at home or, in cases of terminal illness, in a hospice.
To provide hospitalized
patients with flexibility and additional avenues of care, effective January
1, 2002, all non-HMO medical options will provide coverage for up to 120
days (per calendar year) of care delivered in a skilled nursing facility.
These types of facilities, which are operated under the supervision of a
physician and staffed with full-time nurses, are designed to provide care
for hospitalized patients who require a period of confinement, typically
following inpatient surgery. However, current coverage exclusions for custodial
care and maintenance therapy will continue to apply.
What This Change Means To You
If you are covered or are electing coverage under the 90/10, 80/20, POS
or PPO options, and you are anticipating a hospital stay, keep in mind:
- Effective January
1, 2002, home health care benefits will be available if medically necessary—and
will no longer be subject to any minimal hospital stay. Also, coverage
for up to 120 days (per calendar year) of care delivered in a skilled
nursing facility will be available.
- As a general rule,
services and supplies provided at home or in skilled nursing facilities—such
as nursing care, physical therapy, medical supplies and drugs, access
to medical equipment and machines, etc.—are covered as if they were
provided in a hospital.
- For more information
about benefits associated with home health care and skilled nursing
facilities—as well as the administrative certification and referral
requirements associated with these types of care—contact Aetna U.S.
Healthcare 800-541-6711.
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2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.
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Currently, the 90/10, 80/20, POS and PPO medical options provide coverage
for care and services delivered in a hospital—as well as various alternative
care settings, such as at home or, in cases of terminal illness, in a hospice.
To provide hospitalized
patients with flexibility and additional avenues of care, effective January
1, 2002, all non-HMO medical options will provide coverage for up to 120
days (per calendar year) of care delivered in a skilled nursing facility.
These types of facilities, which are operated under the supervision of a
physician and staffed with full-time nurses, are designed to provide care
for hospitalized patients who require a period of confinement, typically
following inpatient surgery. However, current coverage exclusions for custodial
care and maintenance therapy will continue to apply.
