Covered Services and Any Limits
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1 WellCare of South Carolina Covered Services and Any Limits Abortions and related Covered only in the case of rape or incest or if the member s life is in danger Allergy testing and treatment Ambulance transportation Ambulatory Surgical Center (ASC)/Short Procedure Unit (SPU) Behavioral health inpatient (at a general hospital) Behavioral health outpatient facility Certified Registered Nurse Practitioner Chiropractic Limited to manual manipulation of the spine to treat vertebrae misalignment Limited to 1 treatment/visit a day, up to 6 treatments/visits each year Circumcisions Newborns ages 0 days to 6 months Communicable disease (HIV/AIDS, STDs, syphilis, TB) Directly observed therapy for TB Education and counseling Testing Treatment Durable medical equipment (DME) and supplies Items that are not covered include wheelchair accessories $25
2 (EPSDT)/Well-child Physicals for sports are not covered Emergency medical Eye exams for members under age 21 (once each year) Family planning Pregnancy testing Federally Qualified Health Center (FQHC) Hearing (for members under age 21) and ramps, gloves, car/individual lifts, etc. Repairs not covered under the manufacturer s warranty are covered Replacement is covered if the equipment is still medically necessary at the time of replacement Early and Periodic Screening, Diagnosis and Treatment Annual visit Contraception and supplies Family planning and HIV counseling Lab tests Cochlear implants Ear molds 4 for each ear, every year Hearing aids fittings, related hearing, testing Home health Home health aide visits Skilled nursing visits (for members age 18 and under) (for members ages 19 and 20)
3 Therapy visits occupational, physical and speech therapies) Up to 50 visits each year Services that are not covered include full-time nursing, drugs, home-delivered meals, homemaker, routine supplies and home health provided in a nursing home and/or institution Hysterectomy (when medically necessary) Advance written and verbal notification to the member that she will be permanently unable to have children is required; the notification must be signed and dated by the member Hysterectomies are not covered if done only to prevent pregnancy Inpatient hospital (physician care and rehabilitation) Institutional long-term care facilities/nursing homes $25 per admission Limited to the first 90 continuous days Maximum limit of covered days is 120 Internal prosthetic devices Lab and X-ray and diagnostic tests Maternity Birthing centers for obstetrical and newborn care Prenatal, delivery and
4 postpartum and nursery charges Nutritional Counseling The adult covered includes the following: One Initial screening Five face to face behavioral counseling visits with a physician, physician assistant, or a nurse practitioner (individual or group) One initial dietitian visit for nutritional counseling Five follow up visits with a dietician (individual or group) $ Outpatient hospital (non-emergency) Outpatient pediatric AIDS clinic Outpatient rehabilitative therapy Physician Physical therapy, occupational therapy, speech therapy and audiology (for members ages 18 and under) Pharmacy (for members ages 19 and above) Podiatry Preventive and Rehabilitative Services for Primary Care Enhancement (PSPCE/RSPCE) Evaluation of health status and needs Identification of risk factors Development of care plan
5 Education and counseling Rural Health Clinic (RHC) Sterilization (for members age 21 and older who are mentally competent, not in an institution and have consented to the service) Advanced informed consent to the member is required Transplant Bone marrow, cornea, heart, kidney, liver, lung, multivisceral, pancreas, small bowel All provided 72 hours before surgery, post-transplant following discharge and post-transplant pharmacy
Covered Services and Any Limits
WellCare of South Carolina Covered Services and Any Limits Abortions and related Covered only in the case of rape or incest or if the member s life is in danger Allergy testing and treatment Ambulance
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