Limit: 12.0 Visit(s) per Year

Limit: 20.0 Visit(s) per Benefit Period

Only medically necessary cosmetic surgery is covered to treat accidents and genetic defects.

Limit: 1.0 Item(s) per Benefit Period

One pair of glasses (frames and lenses) or one pair of contacts per Benefit Period.

See formulary at mountainhealth.coop for a list of $0 medications.

Coverage will be provided for Habilitative Care services when the Member requires help to keep, learn or improve skills and functioning for daily living. These services include, but are not limited to: physical and occupational therapy; speech-language pathology; and other services for people with disabilities. These services may be provided in a variety of Inpatient and/or Outpatient settings as prescribed by a Physician.

Limit: 180.0 Visit(s) per Benefit Period

Includes Nursing services, Home Health Aide services, Hospice services, Physical Therapy, Occupational Therapy, Speech Therapy, Medical social worker, Medical supplies and equipment suitable for use in the home, Medically Necessary personal hygiene, grooming and dietary assistance.

A coordinated program of home care and Inpatient Care that provides or coordinates palliative and supportive care to meet the needs of a terminally ill Member and the Member's Immediate Family.

We pay for the diagnosis of infertility & Artificial Insemination (but not listed in the contract).

The preparation, administration, or furnishing of parenteral medications, or parenteral or enteral nutritional services to a Member by a Home Infusion Therapy Agency.

The care and treatment of mental illness provided by a hospital; a physician or prescribed by a physician; a mental health treatment center; a chemical dependency treatment center; a psychologist, a licensed social worker; a licensed professional addiction counselor, a licensed clinical professional counselor or a licensed psychiatrist. Outpatient benefits must be provided to diagnose and treat recognized mental illness and treatment must be reasonably expected to improve and restore the level of functioning that has been affected by the mental illness.

Also covered under preventive health care.

Orthodontia for children is only covered when medically necessary.

Rehabilitation Therapy: A specialized, intense and comprehensive program of therapies and treatment services (including but not limited to Physical Therapy, Occupational Therapy and Speech Therapy) provided by a Multidisciplinary Team for treatment of an Injury or physical deficit. Also an Outpatient Therapies benefit.

See formulary at mountainhealth.coop for a list of $0 medications.

Reconstructive breast surgery only. Also covered in case of an accident/ injury or due to treat congenital anomaly.

Also an Outpatient Therapies benefit.

Also an Outpatient Therapies benefit.

Limit: 1.0 Visit(s) per Benefit Period

The following services only may be provided by a licensed ophthalmologist or optometrist operating within the scope of his or her license, or a dispensing optician to Members under 19 years of age: One Routine vision exam per Benefit Period.

Foot care provided to a Member with diabetes.

Limit: 60.0 Days per Benefit Period

Also referred to as 'convalescent home.'