The covered services listed in this table are a summary. This does not mean that all related services will be covered. Covered services are subject to change. For specific exclusions, use the Services Not Covered link above.
|
Service
|
Coverage
|
Copay
|
|
Ambulance
|
Not covered
|
N/A
|
|
Case Management
|
Not covered
|
N/A
|
|
Chiropractor
|
Not covered
|
N/A
|
|
Dental
|
Not covered
|
N/A
|
|
Emergency Department
|
Not covered
|
N/A
|
|
Family Planning
|
Not Covered: Services may be provided at the Saginaw County Health Department at (989) 758-3733.
|
N/A
|
|
Hearing Aids
|
Not covered
|
N/A
|
|
Home Health
|
Not covered
|
N/A
|
|
Home Help (personal care)
|
Not covered
|
N/A
|
|
Hospice
|
Not covered
|
N/A
|
|
Inpatient Hospital
|
Not covered
|
N/A
|
|
Lab & X-Ray
|
Covered if ordered by an MD, DO or NP to a contracted provider
|
$5 copay
|
|
Medical Supplies/Durable Medical Equipment (DME)
|
Limited coverage. Medical supplies are covered except for the following
- Gradient surgical garments, formulas and feeding supplies, and supplies related to any DME item that is not covered.
- DME items are not covered except for glucose monitors.
|
No copays for diabetic supplies
|
|
Mental Health Services
|
Not Covered. Services may be provided through the local community mental health center
|
N/A
|
|
Nursing Facility
|
Not covered
|
N/A
|
|
Optometrist
|
Not covered
|
N/A
|
|
Outpatient Hospital (Not emergency department)
|
Basic x-rays
Diabetic Education (no copay)
|
$5 copay
|
|
Pharmacy
|
Covered if ordered by an MD, DO, or NP. Please refer to page 2 of the SHP handbook, "Prescription Drugs"
|
Discount Program
|
|
Physician/Specialist Nurse Practitioner (NP) Medical Clinic
|
- Annual physical exams including, screening tests such as breast exam and Pap test.
- Flu Shots
- Office visits
Not covered: sterilization and infertility services
Not covered: screening or diagnostic mammograms Contact the Saginaw County Health Department for family planning or breast and cervical screening programs at (989) 758-3676
|
$5 copay
|
|
Podiatrist
|
Limited services.
- When referred by a primary care physician for foot care related to diabetes. Diagnosis codes 250.00-250.93 with procedure codes G0247 and G0246.
- When referred by a primary care physician for foot care related to vascular insufficiency. Diagnosis codes 355.7-355.8 with procedure codes G0247 and G0246.
|
$5 copay
|
|
Prosthetics/Orthotics
|
Not covered
|
N/A
|
|
Private Duty Nursing
|
Not covered
|
N/A
|
|
Substance Abuse
|
Covered through local Mental Health /Substance Abuse programs; must qualify through these agencies.
|
N/A
|
|
Therapies
|
Occupational, physical and speech therapy evaluations are covered when referred by a Primary Care Physician to a free standing facility. Therapy services are not covered in any setting.
|
N/A
|
|
Transportation (Not ambulance)
|
Not covered
|
N/A
|
|
Urgent Care Clinic
|
Not covered
|
N/A
|