PREMIER MEDICAID INTERNATIONAL(HMO) BENEFIT PACKAGE BENEFIT PACKAGE DIALYSIS HOSPITAL INPATIENT COVERED SERVICES
Surgical procedures (minor to intermediate)
Internal surgical appliances/such as prosthesis and
External surgical appliances/such crushes,elastic stockings
Blood transfusion (international blood care services)
PSYCHIATRIC / BEHAVIOURAL HEALTH SERVICES
Evacuation and treatment of conditions that are
Medical Services: Covered Outpatient and inpatient
medical services Provided by a physician,i.e. individual
psychotherapy, groupPsychotherapy, psychological testing,
family counseling –with family Members to aid diagnosis
Orthotics for treatment related to injurie
or strains e.g. cervical & lumber braces
Orthotics for medically necessary rehabilitation of
LOWER LIMB VERTEBRAL SPINE ULTRASOUND DIAGNOSTIC LABORATORY TESTS HEMATOLOGY SEROLOGY BLOOD CHEMISTRY URINE CHEMISTRY MICROBIOLOGY
Stool microscopy,culture and sensitivity
Sputum microscopy,culture and sensitivity
HORMONE ASSAY
Members” prescriptions will be filled from essential drugs list i.e. a
Recommended list of essential brand name and generic drugs,which
Have been chosen because they provide maximum quality and value
REHABILITATION SERVICES{outpatient short term therapy} Rehabilitation Services include SURGICAL SERVICES
Surgical supplies normally required for covered surgical procedure
Anaesthesia normally required for covered surgical procedures
Administration of blood and blood plasma
Impatient or Outpatient minor or immediate surgeries
MINOR SURGERIES INCLUDING BUT NOT LIMITED TO THE FOLLOWING
Sub-periosteal drainage for acute osteomyelitis
Tonsil ectomy for children (less than 12yrs)
Closed reduction and immobilization of joint dislocation
Injection sclerotherapy of varicose veins
INTERMEDIATE SURGERIES INCLUDING BUT NOT LIMITED TO THE FOLLOWING
Laparotomy and biopsy of disease viscera in abdominal cavity
Surgical drainage of hematoma of abdominus
Major surgeries
Orthopaedic Procedures requiring implants
Scaling and polishing(once every six months)
Dental treatment as a result of accidental damage
MATERNITY CARE
Physician prescribed bed rest during pregnancy
Termination of pregnancy for life-endangering condition
Hospitalization and skil ed nursing in connection with childbirth for the
Mother or newborn child of a virginal or caesarean delivery
TERTIARY RADIOLOGICAL INVESTIGATIONS SUCH AS CT SCAN, MRI, MAMMOGRAM
Gynecological investigation-Hormonal profile, Semen analysis, etc
OPITICAL SERVICES
Supply of Frames(within limit once a year)
Supply of lenses(unifocal,bifocal,varifocal or contact once a year)
EXCLUSIONS
Artificial limbs& dentals prostheses
Specific treatment for AIDS/HIV positive patients
For the EXECUTIVE plan the benefit package includes post operative monitoring, home visits or home
care include physiotherapy for two weeks where necessary.
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Express Scripts, Inc. ***Most step therapy programs have exception criteria for members taking certain medications and/or medical histories. Depending on a member's specific medical history, a back-up medication may be approved without a trial of a front-line medication.*** Step Therapy Your prescription is for one of Your program points you to one of This program looks for