This benefit is available only if you are enrolled in the Retired Trust Medical Plan. Home health care benefits provide payment of 70% (80% for preferred providers and 80% if there are fewer than two Preferred Provider primary care physicians within a 30 mile radius of your primary residence) of eligible home health care charges for a single visit. These benefits are payable up to a maximum of 100 visits during a calendar year.

Covered Charges

Charges are covered for illness or accidental bodily injury:

1. Which do not arise out of or in the course of any employment, or

2. For which you are not entitled to benefits under any Workers' Compensation law.

The charges must be:

1. Medically necessary for your treatment, and you are totally disabled and, in the opinion of your physician, would otherwise be confined as a registered bed patient in a hospital or skilled nursing facility. Additionally:

a. You are under the direct care of a physician;

b. The plan of treatment covering home health care is established in writing by your physician prior to commencement of such treatment;

c. The plan of treatment covering home health care is reviewed and updated in writing by your physician at least once every month; and

d. You are examined by your physician at least once every 60 days.

2. The services must be provided by a home health agency that meet the following requirements:

a. It is primarily engaged in and is federally certified as a home health agency and is duly licensed, if such licensing is required, by the appropriate licensing authority to provide nursing and other therapeutic services (as listed in this section of the benefit booklet);

b. Its professional service policies are established by a professional group associate with such agency or organization, including at least one physician and at least one registered nurse, to govern the services provided;

c. It provides for full-time supervision of home health care service by a physician or by a registered nurse;

d. It maintains a complete medical record for each patient; and

e. It has an administrator.

3. Are for charges that are incurred for one or more of the following, unless such charges are covered charges under the Medical Benefits portion of this benefit booklet:

a. Part-time or intermittent nursing care by a licensed practical nurse;

b. Service by a registered nurse;

c. Skilled Nursing Care (including but not limited to):

i. Giving of injections, including IVs;

ii. Changing and irrigating urinary catheters;

iii. Drawing blood for testing;

iv. Taking of blood pressure;

v. Giving insulin shots;

vi. Use of oxygen and breathing machines;

vii. Treatment of bed sores and other skin problems; and

viii. Bandaging surgical incisions.

d. Speech language therapy for lost communication skills (due to an accident) including but not limited to:

i. Teaching communication skills;

ii. Alternate means of expression; and

iii. Help with choking or swallowing problems.

e. Physical therapy (including but not limited to):

i. Planning an exercise program;

ii. Teaching balance and coordination skills; and

iii. Easy approach to getting in and out of a wheelchair or bed.

2. Charges for services performed by your immediate family or any person residing with you;

3. Charges for general housekeeping services (except as specified under the Home Maker Services Benefit section); and

4. Charges for services for custodial care (except as specified under Inpatient Custodial Care Benefit section).