5.16 HOME HEALTH CARE BENEFIT

The Plan will extend a benefit for Medically Necessary home health care, including home I.V. therapy services, rendered by a Licensed Home Health Care Agency, for care which would have been covered under the Plan if services were performed in a Hospital or Skilled Nursing Facility.

Covered Expenses are reimbursed at 80% if provided by a Preferred Provider. If services are provided by a non-Preferred Provider in the Anchorage area, Covered Expenses are reimbursed at 60% of the rate negotiated with the Preferred Provider. If services are provided by a non-Preferred Provider outside the Anchorage area, Covered Expenses are reimbursed at 60%. Covered Expenses are also subject to the calendar year deductible.