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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

The following types of nutrition therapy are covered:

  • Enteral Nutrition (EN). EN is the provision of nutritional requirements via the gastrointestinal tract. EN can be taken orally or through a tube into the stomach or small intestine.
  • Parenteral Nutrition Therapy (PN) and Total Parenteral Nutrition (TPN). PN is liquid nutrition administered through a vein to provide part of daily nutritional requirements. TPN is a type of PN that provides all daily nutrient needs. PN or TPN are covered when the member’s nutritional status cannot be adequately maintained on oral or enteral feedings.
  • Intradialytic Parenteral Nutrition (IDPN). IDPN is a type of PN that is administered to members on chronic hemodialysis during dialysis sessions to provide most nutrient needs. IDPN is covered when the member is on chronic hemodialysis and nutritional status cannot be adequately maintained on oral or enteral feedings.

Nutrition therapy is covered when it meets all of the following criteria:

  • Sole source of nutrition or a significant percentage of the daily caloric intake;
  • Used in the treatment of, or in association with, a demonstrable disease, condition or disorder;
  • Prescribed by a provider;
  • Necessary to sustain life or health; and
  • Requires ongoing evaluation and management by a provider.

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