Benefits & Coverage

Basic, BasicPlus, & RetiCare Options

 Medical CostsCovered. The BasicHealth Option shall provide, pay for, arrange for, or reimburse one hundred percent (100%) of the cost of the following basic medical care, subject to the exclusions set forth in Part 3, and subject to the payment of Co-payment,  deductibles  and other  charges not covered  by the  Plan:

(1) Primary  care, including  emergency  room  and out-patient   minor  surgical procedures;

(2) Specialist and consultant care;

(3) Specialist and consultant   care for  developmental   need and/or  special needs person including  physically  disabled  care for vision,  hearing,  and speech disabilities

(4) Specialist and consultant  care for  Occupational  therapy  needs limited  to 24 sessions   per fiscal year

(5) Diagnostic  procedures,  including  x-rays and laboratory   tests;

(6) Maternity   care, including  pre-natal,  delivery,  and post-natal  care, as well as nursery  care of newborn  during  mother’s  confinement   for  maternity,  and first well  baby check-up  that  accompanies  the  post-natal  care check-up  of the mother  and associated complications   of the  new born  prior  to  newborn’s enrollment.

(7) Well child care, including  immunizations   and boosters;

(8) Family planning   services, subject  to the limitations   set out in this  Part;

(9) Routine  physical examinations,   once each fiscal  year at local medical providers.  Not applicable  to overseas medical  providers.   Physical examinations for  school or work  purposes are not covered.

(10)    Hospital   care;

(11)    In-patient   physician  and surgeon’s  care; (12) Blood and blood derivatives;

(13) Short term  physical therapy,  not exceed ~      ninety  days per calendar year; (14) Medications   which  are only available  by prescription;

{15) Prosthetic  appliances,  subject  to the limitations   set out  in this Part;

(16) Vision care, subject to the  limitations   set out  in this Part; and

(17)  Dental care, subject to the limitations set out in this Part.

(18) Necessaryincidentals for the treatment or procedure of patient  is covered, items such as shaving kits. adult pampers or diapers