• Assistive listening devices for televisions (including amplifiers and caption decoders) • Assistive listening devices for use with cochlear implants • Assistive listening devices, supplies, and accessories not otherwise specified • Hearing aid batteries Home health care ALERT! See the “What the plan does not cover” section for services the plan does not cover. In certain circumstances, the plan covers short-term, provider-directed, medically necessary home health services on an intermittent or part-time basis by a licensed home health, hospice, or home care agency, to help a member recover from an acute covered illness, injury, or hospital stay. Home Health care is provided through visits from specialized clinicians, performing specific tasks (rather than time-based shifts), on a short-term basis, until specified individual goals are met. These services must be part of a treatment plan written by your provider (such as your physician or advanced registered practitioner [ARNP]). The provider must certify that you are homebound. These short-term visits may include: • Skilled nursing care, physical, occupational, or speech therapy • Home health aides and clinical social services, provided in conjunction with the skilled services of a registered nurse (RN), licensed practical nurse (LPN) or physical, occupational, or speech therapist • Disposable medical supplies as well as prescription drugs provided by the home health agency • Home infusion therapy • Home care of wounds resulting from injury or surgery • End-of-life counseling (see page 50) For services that may be covered under another benefit, such as nutritional counseling or follow-up care for bariatric surgery, see that benefit in this COC for coverage rules and limitations. These limitations apply even if the services are provided in the home or by a home health provider. For information on substitution of private duty nursing as an alternative benefit in lieu of hospitalization or in lieu of admission to a skilled nursing facility, see page 56 (hospital services) or page 68 (skilled nursing facility). Contact UMP Customer Service if you have questions. Hospice care Hospice (inpatient, outpatient, and respite care) is services provided by a state-licensed hospice program in the home or in a hospice facility to terminally ill patients. Services include pain relief care and support services that address the needs of terminally ill members and their families without intent to cure. Medical Hospice services received from preferred and participating providers are covered at 100 percent of the allowed amount after you meet your medical deductible. The plan covers hospice care for terminally ill members for no more than six months. See page 50 for coverage of end-of-life counseling. If you need hospice care, your provider will refer you to the program. For additional assistance, you may contact UMP Customer Service. 54 2024 UMP Classic (PEBB) Certificate of Coverage