| Service |
Description |
| Ambulance Services |
Covers emergency transfers to or from a beneficiary’s home, accident scene, or other location to a hospital and transfers between hospitals; ambulance transfers from a hospital-based emergency room to a hospital more capable of providing the required care; and transfers between a hospital or skilled nursing facility and another hospital-based or freestanding outpatient therapeutic or diagnostic department/facility.
Excludes ambulance service used instead of taxi service when the patient’s condition would have permitted use of regular private transportation; transport or transfer of a patient primarily for the purpose of having the patient nearer to home, family, friends, or personal physician; and Medicabs or ambicabs that function primarily as public passenger conveyances transporting patients to and from their medical appointments.
|
| Ancillary Services |
Certain diagnostic radiology and ultrasound; diagnostic nuclear medicine; pathology and laboratory services; and cardiovascular studies |
| Durable Medical Equipment (DME) |
Generally covered if medically necessary and appropriate, and if prescribed by a physician for the specific use of the beneficiary. Duplicate items of DME that are essential to provide a fail-safe, in-home, life-support system are covered. In this case, “duplicate” means an item that meets the definition of DME and serves the same purpose but may not be an exact duplicate of the original DME item. For example, a portable oxygen concentrator may be covered as a backup for a stationary oxygen generator. |
| Emergency Services |
Emergency services are covered for medical, maternity, or psychiatric conditions that would lead a “prudent layperson” (someone with average knowledge of health and medicine) to believe that a serious medical condition exists; that the absence of medical attention would result in a threat to the patient’s life, limb, or eyesight; that the patient may be a danger to self or others and requires immediate medical treatment; or that the patient manifests painful symptoms requiring immediate palliative effort to relieve suffering. |
| Eye Examinations |
- Active duty family members: One routine eye examination per year
- Retired service members, their families, and others: Not covered after age 6
|
| Home Health Care |
Part-time or intermittent skilled nursing services and home health services; physical, speech, and occupational therapy; medical social services, and routine and non-routine medical services. All care must be provided by a participating home health care agency and be authorized in advance by Humana Military. |
| Individual Provider Services |
Office visits; outpatient officebased medical and surgical care; consultation, diagnosis, and treatment by a specialist; allergy tests and treatment; osteopathic manipulation; rehabilitation services (e.g., physical therapy, speech pathology services, and occupational therapy); and medical supplies used within the office. |
| Laboratory and X-ray Services |
Generally covered if prescribed by a physician. (Some exceptions apply, e.g., chemo-sensitivity assays and bone density X-ray studies for routine osteoporosis screening.) |
| Papanicolaou (Pap) Smear |
Covered as either a diagnostic or routine preventive procedure. The HPV Pap test is not covered as a routine screening Pap smear. |
| Prosthetic Devices and Medical Supplies |
Generally covered if prescribed by a physician and is directly related to a medical condition. Prosthetic devices must be FDA-approved. |
