 You receive prior authorization from Kaiser in accordance with Utilization Review criteria developed by Medical Group and approved by Kaiser.  Services are provided through a licensed Home Health Agency. Home Health Services Exclusions  “Meals on Wheels” or similar food services.  Nonmedical, custodial, homemaker or housekeeping type services except by home health aides as ordered in the approved plan of treatment.  Private duty or continuous nursing Services.  Services designed to maintain optimal health in the absence of symptoms.  Services not included in an approved plan of treatment.  Services of a person who normally lives in the home or who is a member of the family.  Services that an unlicensed family member or other layperson could provide safely and effectively in the home setting after receiving appropriate training. These Services are excluded even if we would cover the Services if they were provided by a qualified medical professional in a hospital or skilled nursing facility.  Supportive environmental materials such as handrails, ramps, telephones, air conditioners, and similar appliances and devices. 15. Hospice Services Hospice is a specialized form of interdisciplinary care designed to provide palliative care to help alleviate your physical, emotional, and spiritual discomfort through the last phases of life due to a terminal illness. It also provides support to your primary caregiver and your family. When you choose hospice, you are choosing to receive palliative (comfort) care for pain and other symptoms associated with the terminal illness, but not to receive care to try to cure the terminal illness. You may change your decision to receive hospice Services at any time. We cover hospice Services if all of the following requirements are met:  A Medical Group physician has diagnosed you with a terminal illness and determines that your life expectancy is six months or less.  The Services are provided in your home (or a place of temporary or permanent residence used as your home).  The Services are provided by a licensed hospice agency approved by Kaiser Foundation Hospitals.  The Services are necessary for the palliation and management of your terminal illness and related conditions.  The Services meet Kaiser Utilization Review criteria. The following hospice Services are covered (Deductible may apply):  Counseling and bereavement Services for up to one year.  Durable Medical Equipment (DME).  Home health aide Services.  Medical social Services.  Medication and medical supplies and appliances.  Participating Provider Services. EWCLGHDHP1983ACT0124 48 WAPEBB-CD-ACT