2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Home Health Services
Section 5. Benefits
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Home Health Services
Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Section. There is no calendar year deductible under Basic Option.
Benefit Description
Home Health Services
Home nursing care (skilled) for two hours per day when:
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Note: Benefits for home nursing care are limited to 50 visits per person, per calendar year.
Note: Visits that you pay for while meeting your calendar year deductible count toward the annual visit limit.
Basic Option - You Pay
Preferred: $30 copayment per visit
Note: You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 152 for more information about “agents.”)
Note: Benefits for home nursing care are limited to 25 visits per person, per calendar year.
Participating/Non-participating: You pay all charges
Benefit Description
Home Health Services
Home nursing care (skilled) for two hours per day when:
- A registered nurse (R.N.) or licensed practical nurse (L.P.N.) provides the services; and
- A physician orders the care
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Note: Benefits for home nursing care are limited to 50 visits per person, per calendar year.
Note: Visits that you pay for while meeting your calendar year deductible count toward the annual visit limit.
Basic Option - You Pay
Preferred: $30 copayment per visit
Note: You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 152 for more information about “agents.”)
Note: Benefits for home nursing care are limited to 25 visits per person, per calendar year.
Participating/Non-participating: You pay all charges
Benefit Description
Not covered:
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges
Not covered:
- Nursing care requested by, or for the convenience of, the patient or the patient’s family
- Services primarily for bathing, feeding, exercising, moving the patient, homemaking, giving medication, or acting as a companion or sitter
- Services provided by a nurse, nursing assistant, health aide, or other similarly licensed or unlicensed person that are billed by a skilled nursing facility, extended care facility,
or nursing home, except as included in the benefits described on pages 88-89.
- Private duty nursing
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges