Hospice Hospice care when provided by a licensed hospice care No charge; Enrollee pays nothing program. A hospice care program is a coordinated program of home and inpatient care, available 24 hours a day. This program uses an interdisciplinary team of personnel to provide comfort and supportive services to an Enrollee and any family members who are caring for the Enrollee, who is experiencing a life-threatening disease with a limited prognosis. These services include acute, respite and home care to meet the physical, psychosocial and special needs of the Enrollee and their family during the final stages of illness. In order to qualify for hospice care, the Enrollee’s provider must certify that the Enrollee is terminally ill and is eligible for hospice services. Inpatient Hospice Services. For short-term care, inpatient hospice services are covered with Preauthorization. Respite care is covered to provide continuous care of the Enrollee and allow temporary relief to family members from the duties of caring for the Enrollee for a maximum of 5 consecutive days per 3-month period of hospice care. Other covered hospice services, when billed by a licensed hospice program, may include the following: • Inpatient and outpatient services and supplies for injury and illness. • Semi-private room and board, except when a private room is determined to be necessary. • Durable medical equipment when billed by a licensed hospice care program. Hospice care requires Preauthorization. Exclusions: Private Duty Nursing, financial or legal counseling services; meal services; any services provided by family members Hospital - Inpatient and Outpatient The following inpatient medical and surgical services are Hospital - Inpatient: After Deductible, Enrollee covered: pays $150 Copayment per day up to $750 per • Room and board, including private room when admission prescribed, and general nursing services. • Hospital services (including use of operating room, Hospital - Outpatient: After Deductible, Enrollee anesthesia, oxygen, x-ray, laboratory and radiotherapy pays $150 Copayment services). • Drugs and medications administered during confinement. • Medical implants. • Withdrawal management services. Outpatient hospital includes ambulatory surgical centers. PEBB_CA_2024 26