Home Health Care Expense Benefit
If the Insured has been confined in a Hospital or a skilled nursing facility for at least 3 continuous days prior to incurring expenses for Home Health Care and the illness or Injury requiring Home Health Care commenced while an Insured was insured under this Policy, then the Company will pay up to the daily Hospital room and board benefit provided under the Policy for each of the first three days of Home Health Care Services. Thereafter each day of Home Health Care benefits shall not exceed one-half the daily Hospital room and board benefit provided under the Policy during the period of prior confinement. Home Health Care expenses shall be limited to the Usual and Customary Charges for such services.
It is understood that Home Health Care expenses shall be limited to part-time and intermittent care, except when full-time or 24-hour services are needed on a short-term basis (no more than 3 days) for the following services:
- Nursing care furnished by or under the supervision of a Registered Nurse; physical therapy; occupation therapy; medical social work; nutrition services; medical appliances and equipment, drugs and medications, laboratory services and special meals, to the extent such items and services would have been covered under the Policy if the Insured had been in a Hospital; any diagnostic or therapeutic service, including surgical services; performed in a Hospital outpatient department, a doctor's office or any other licensed health care facility to the extent that such service is delivered as part of a Home Health Care plan.
For determining the limits of benefits, each visit by a member of a Home Health Care team shall be considered as one Home Health Care visit. Charges for Home Health Care services incurred with respect to an Insured shall be limited to 60 visits in any calendar year.