BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012
Service
Outpatient Hospital
BadgerCare Plus Standard
Plan and Medicaid SSI
Full coverage with no
copayment.
BadgerCare Plus
Benchmark Plan
Full coverage with a $15.00
copayment per visit.
Multiple visits to the same
provider on the same day
will be treated as a single
visit.
BadgerCare Plus Core Plan
Full coverage with no
copayment for members
with income up to 100%
FPL.
$15 copayment per visit for
members with income from
100-200% FPL
Personal Care
Services
Physical Therapy
(PT), Occupational
Therapy (OT) and
Speech-Language
Pathology (SLP)
Full coverage with no
copayment.
Full coverage with no
copayment.
Not Covered.
Full coverage with a limit of
20 visits per therapy type
per enrollment year. $15.00
copayment per visit, per
provider. A therapy visit is
defined as all therapy
services delivered on the
same date of service by the
same performing provider.
The copayment applies
regardless of the number or
type of procedures
administered during the visit.
An additional 36 visits are
covered for cardiac
rehabilitation. Also covers
up to a maximum of 60 SLP
therapy visits over a 20-
week period are covered
following a bone anchored
hearing aid or cochlear
implant surgeries for
members 17 years and
younger
$300 total copayment cap
per enrollment year for
inpatient and outpatient
hospital services for
members with income from
100-200% F.P.L.
Not Covered.
Full coverage with no
copayment. Covers up to
20 visits in each therapy
discipline per member per
enrollment year.
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