Services in Your Home
For services in your home, you pay 20%, subject to deductible, depending upon the type of provider or service rendered. The Plan covers the following network provider services when rendered in the patient's home, provided that the services are medically necessary covered health services and are not considered custodial care, as determined by Anthem Blue Cross or KPIC:
  • Nursing services provided by a registered nurse (R.N.), or a licensed vocational nurse (L.V.N.) or licensed practical nurse (L.P.N.) when under the supervision of an R.N.
  • Services of a home health aide.
  • Physical, occupational, speech or respiratory therapy and supplies; medical social services; and covered nutritional counseling.
  • For a patient formally admitted to a network hospice program: homemaking services; counseling for the patient and family members; up to three days of respite care during a six-month period; and bereavement counseling by a certified social worker who is an employee of the hospice, for up to 12 months after the patient's death. Bereavement counseling benefits are limited to $25 per visit, four visits per family.
For Anthem HAP members, one visit by a home health aide equals four hours or less.
For KPIC HAP members, for any visit by a nurse, medical social worker, or physical, occupational, or speech therapist that lasts longer than two hours, each additional increment of two hours counts as a separate visit. If a visit by a home health aide lasts longer than four hours, then each additional increment of four hours counts as a separate visit.