Wellcare CalViva Health Dual Align (HMO D-SNP): Skilled Nursing Facility (SNF) Care

Skilled Nursing Facility (SNF) care and rehabilitation services are provided on a continuous daily basis in a skilled nursing facility. Examples of care include physical therapy, medications that can only be given by a registered nurse, or complex wound care that cannot be performed in the home. Typically, but not always, admission to an SNF follows a hospitalization and is utilized as post-acute care before returning home.

Covered services include but are not limited to:

• Semiprivate room (or a private room if medically necessary)

• Meals, including special diets

• Skilled nursing services

• Physical therapy, occupational therapy, and speech therapy

• Drugs administered to you as part of your plan of care (this includes substances that are naturally present in the body, such as blood clotting factors)

• Blood - including storage and administration*

• Medical and surgical supplies ordinarily provided by SNFs

• Laboratory tests ordinarily provided by SNFs

• X-rays and other radiology services ordinarily provided by SNFs

• Use of appliances such as wheelchairs ordinarily provided by SNFs

• Physician/Practitioner services 

Generally, you will get your SNF care from network facilities. However, under certain conditions listed below, you may be able to pay in-network cost-sharing for a facility that isn’t a network provider, if the facility accepts our plan’s amounts for payment.

• A nursing home or continuing care retirement community where you were living right before you went to the hospital (as long as it provides skilled nursing facility care)

• A SNF where your spouse is living at the time you leave the hospital 

*Coverage of whole blood and packed red cells begins only with the fourth pint of blood needed—costs for the first 3 pints of blood in a calendar year must be paid out-of-pocket or the blood must be donated from self or by someone else. All other components of blood are covered beginning with the first pint.

BENEFIT PERIOD: There is no limit to the number of benefit periods. A "benefit period" starts on the day of admission to a hospital or skilled nursing facility. It ends after 60 days in a row without hospital or skilled nursing care. Upon hospital admission, after one benefit period has ended, a new benefit period begins.