In summary of the change, A physical therapist may evaluate and initiate treatment on a patient without a prescription or referral from an approved health care provider. Therefore, our health plan document has been amended to reflect this change. All health plan coverage is subject to medically necessary guidelines, patient eligibility, and terms and conditions as outlined in the plan document.

Health plan amendment:

Page 37, covered Charges, item (9) other medical services and supplies, (bb) therapies are covered under this plan as follows: (iii) Physical Therapy is replaced with the following:

Physical Therapy by a licensed physical therapist or licensed physical therapy assistant within the scope of their state licensure. Preauthorization of therapy is recommended. The therapy must be expected to produce a significant improvement of the Covered Persons’s condition withing a two (2) month period. The accepted level of rehabilitation is when the Covered Person can preform basic Activities of Daily Living. The need for the therapy, the care and the regimen established must be documented in writing for each two (2) month period. Thes therapy is subject to the reasonable and necessary, restorative therapy and maintenance provisions as found in the defined terms section of the plan. (Refer To Habilitative services under this plan for benefits for non-restorative therapy).

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