Free Motion to Certify Class - District Court of Arizona - Arizona

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l .· i O“*P“**°“* S“*’S*““°° “*’“S6 the Bank of America medical plan when the faculty
Ag]; ._.. -=--, The plan’s payment for the outpatient and nonhospital IS aeeepted by Mcdicgyc er Whcnthcfa,cil1ty_
. .. . l **66*0*60* nf $**05*6**66 6****$6 *8 *******60 $66 ***6 — Is licensed to provide inpatient skilled nursmg
`* V`: l · I “N[€dlCE\l l3€I1BfllLS Cl‘13.I’t” l3ICI’ 111 lLl'l1S chapter. and Physica] rcgtcyattcn gcrvjccs
— Is under the supervision of a physician or regis-
**0***6 health- $*****6** *****5**'*S` *a€****Y tered nurse and provides 24-hour patient care by
and h0$P*€6 66*6 a staff of licensed nurses under the direction of
E The following are covered medical services only if the a t"a];-ttme ycgtgtcpcd nurse
3 l'¥`l€d1CEll pl31’1 ElCiI'l'1lIl1ST.1'EII0l' C€I“IZ1llCS ll] 3.ClV3.I1C€ that ... Hag an gctjvc utihzgjjctg f@V1€W p]3_n for all
tn.- the care 1S medically necessary If these services are patigntg
S DOI pI`CCCYt1HCd, HO pB.yID€Dt IS Hladc under thC plan - IS not 3 placg for rest, tha aged, alcoholjsub-
•* stance abuse patients, custodial or educational
`U **0***6 **66**** 66*6 **6**6***6 care or care of mental health disorders or mental
QT Benefits are limited as shown in the "Medical benefits retardation
= chart" later 1n this chapter. Each visit by an employee
G uf 6 **0***6 **6****** 66*6 6g6**0Y will **6 60**5*06*6d 0**6 Nursing services and restorative services must be
'U hOH'1€ hCEl.lll1 C&l"C VlSl[, 31TCl B3.Cl1 f0l.lI‘ ll10l.11’S of l'1OI1’1C I-t-gccjtrcd by [hc pgttjcntj and {hc cgyc rcccivcd must
Q: health aide services will be considered one home be expected to improve the patient’s condition and
Q **63**** 66*6 **151*- H0***6 **66**** 6&F6 $6****065 ***6*****6 facilitate discharge from the skilled nursing facility.
3 mtermtttent visits by professional nurses and other
professionals for a member who; Hospice care
' **6610**66 $*****6** 06*6 · Hospice care includes charges due to terminal
° *5 **0**$6b0****‘* ****6 tn 6 0*66******E 60**0***00 illness for the followin hos ice care services
° Is LlI]3bl€ lZCI 1'CCBlVC I'I1BdiC3.l CHIC OI] BD 3.I'I1lD`l.1lH.tO}`y prgvldcd undcf gt hospggg caic p[0gfam_
OUtpB.tlCHt basis Hlld does I'10[ I`€ql.1l1'C CXlLSIIdCd - Bed and b0a_t·d’ Sgrvuxs and supp[]_gS’ cxggpt
3lZtCHtZlOH 3 p[`OfCSSlO[l3,] 1'1LlI`S€ OI` fO1' OlZhCI° that for any day Of Cgnfingmgnt tn al pnvatc
*6650**6 *6*1****66 00******6***6*** 1** 6 **051***6* 0* room, covered expenses do not include that
$*****60 *****3***g *60****5* portion of the charges that are more than the
hos ice bed and board limit shown in the
The annual maximum does not apply to services Sehgdale
provided for home infusion therapy. Home infusion - Hgsptcg faeittty Sertaees proytdgd gn an
therapy 1S defined as services provided by an approved Outpatient basis
**0***6 infusinn 60***1*6**Y nniy *****6** S6*`V*66$ 6*6 — Professional services provided by a physician
]`H€d1CH.lly IICCCSSHTY and OI°d€ICd 31] 3ttCDdlHg - [ndiytdual and cgunsghng 3
phySlC12I.I1, HOHIC iHfUS1OII S€I'VlCBS i1'1Cll1d€ HIC pharma- psychglggigt, soma] workgr, Cgunsglgr
ceutical, administered intravenously, medical supplies Or Ordamed mtmstea tncludtng three
6**** 6**Y *****$***B S6*’·’*66S *6*1*6*6** *0 $**1*1*0** ***6 bereavement counseling sessions within
infusion. Nursing services mclude the administration gng yggy after tha pal-Srm’S dgath
of the lHtI`a,V€H.Ol.1S H`.I.€diCaUOH, Incdically HCCESSBIIY, - Pain [gligf trgatincnh Including drugs,
Bild 3Ily lab tests, dI`BSSiI1g changes HI°1d IIHC CHIC. mgdicingg and mcdlcal Supplies
S — Home health care agency services for
*****6** *****6***8 *66****Y 66*6 — Part—time or intermittent nursin care b
° Whcn YOU are COI1V&lCSCl11g f[‘OHI an illness OY Or under the Supcrvislctn Of a nlgjsc y
injury, your physician may rncnnnnnnd that ynu e Pntt-tnnn ct intermittent services by n
receive treatment in a skilled nursing facility. This heme health aide
stay In B. nursing must be PFC- i Physical} Occupational and Speech therapy
approved by a medical plan medical consultant and - Medica] Supplies, drugs and medicines lawfully
*; ****;**601*10 ***·‘i ***6X******;** 5**00*** in ***6 “M6***06* dispensed only on the written prescription of
ene its c art" ater in t is chapter. a physlctan
· A Skilled nunins faniiny qunnnts for cnycrnan under - Laboratory ncnnccn, but only to the extent
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case 2:03-cv-02262-Ros Document 158-27 Fuecn 10/O7/2005 Page 1 ct*°1*°0235

Case 2:03-cv-02262-ROS

Document 158-27

Filed 10/07/2005

Page 1 of 1