Not a covered benefit.
Hearing aids and related services are only covered for active duty family members with profound hearing loss. More >>
Hearing screenings are covered for newborns as defined by the American Academy of Pediatrics and Joint Committee on Infant Hearing, and should be performed before the newborn is discharged from the hospital or within the first three months. Evaluative hearing tests may be performed at other ages during preventive exams.
Portable heart monitors, such as a Holter Monitor, are covered when prescribed by a physician as a diagnostic tool for a suspected medical condition. They are generally rented for a couple of days but may be required for a longer period of time depending on the medical need. Personal heart rate monitors used by a beneficiary to track/monitor their own heart activity are not a covered benefit.
Home health care is covered for skilled nursing care and physical, speech and occupational therapy. Providers following the prospective payment system (PPS) may be authorized for a maximum of 28 hours per week part time or 35 hours per week intermittent. Providers following the corporate payment system (CPS) may be authorized for a maximum of 15 hours per week. Care must be provided by a participating home health care agency. The beneficiary must have a plan of care approved by a physician and be confined to the home. There may be separate charges for durable medical equipment, supplies, prosthetics, and specific drugs with applicable copayments and cost shares. Prior authorization is required for all beneficiaries.
Home infusion therapy is a limited benefit. More >>
Hormone replacement therapy may be a covered benefit when used to treat hormone deficiencies, for example, hypothyroidism. Hormone replacement therapy for menopause is a covered benefit for women when used to treat menopausal symptoms or to prevent osteoporosis or other conditions associated with menopause. Most medications are available through Express Scripts. Providers should contact Express Scripts to determine approval and availability. Providers who plan to administer injectable specialty drugs not available through Express Scripts may order specialty drugs through a specialty pharmacy (specialty drug supplier) which may require prior authorization if administered in the home. Hormone injections for the treatment of organic impotency are a covered benefit when the medication is approved by the U.S. Food and Drug Administration (FDA) and used for an FDA-approved indication. Growth hormone is a limited benefit. Subcutaneous implantable estradiol pellets for women are not a covered benefit.
Hospice care is a covered benefit. There may be separate charges for durable medical equipment, prosthetics, and specific drugs with applicable copayments and cost shares. Room and board is not covered under hospice care unless the patient is receiving authorized inpatient or respite level of care. Services/treatment related to the terminal illness (other than hospice care) are not covered. An approval is required for all beneficiaries. Learn more about hospice care within our Case Management program.
Hospitalization for behavioral health is covered, regardless of length of stay, as long as care is considered medically or psychologically necessary and appropriate. All non-emergency admissions require prior authorization for all beneficiaries, including beneficiaries with other health insurance.
Inpatient hospitalization is a covered benefit and includes: semiprivate room (and, when medically necessary, special care units), general nursing, hospital service, inpatient physician and surgical services, meals (including special diets), drugs and medications while an inpatient, operating and recovery room, anesthesia, laboratory tests, X-rays and other radiology services, necessary medical supplies and appliances, and blood and blood products. See the prior authorization requirements to determine if approval is required.
HPV DNA testing is a covered benefit for females age 30 and older as a cervical cancer screening when performed with a Pap smear, also known as a Pap test.
The human papillomavirus (HPV) vaccine is a limited benefit and may be covered when the beneficiary has not been previously vaccinated or completed the vaccine series. More>>
A hysterectomy is a limited benefit and only covered when medically necessary. More >>