🏥Hospital & Facility
(5c)
(5c)
This type of care includes room, board, and general nursing services.
What is inpatient hospital care?
This is NOT required before receiving prescription drug benefits under 5(f).
What is a deductible?
These services are covered when dental damage is caused by this type of event.
What is an accidental injury?
This benefit supports patients with serious illnesses and end-of-life planning.
What is compassionate care?
This situation may limit payment if another insurer is primary.
What is coordination of benefits?
This facility provides up to 90 days of recovery care after hospitalization.
What is skilled nursing facility care?
This list determines how medications are covered and what you pay.
What is the formulary?
This preventive service helps detect cavities early.
What is a dental exam?
This network designation lowers costs for certain advanced therapies.
What is the GCIT™ network?
This category includes services primarily for personal comfort or convenience.
What are comfort or convenience items?
This type of surgery does NOT require an overnight hospital stay
What is outpatient surgery?
This may be required before certain specialty medications are approved.
What is prior authorization?
This procedure restores a damaged tooth.
What is a filling?
This program helps coordinate care for complex medical conditions.
What is case management?
This type of surgery is excluded unless needed to correct a functional problem or injury.
What is cosmetic surgery?
This service provides comfort-focused care for terminal illness.
What is hospice care?
These high-cost medications often require special handling and approval.
What are specialty drugs?
This may be covered when medically necessary during certain procedures.
What is anesthesia?
These cutting-edge treatments may have special network requirements.
What are gene-based therapies?
This category includes treatments not proven effective through clinical evidence.
What are experimental or investigational treatments?
This is required before many inpatient admissions to avoid penalties.
What is precertification?
This process allows the plan to review whether a medication is medically necessary
What is utilization management?
This type of dental service is typically NOT covered unless related to injury.
What is routine orthodontia?
This planning discussion ensures a member’s medical wishes are documented.
What is advance care planning?
This type of service fee, unrelated to treatment, is excluded.
What are administrative fees?