Covered Services

GVHP offers you and your family a broad range of services as outlined in your MIChild Certificate of Coverage. There are no deductibles or co-payments to pay. Please refer to your GVHP MIChild Certificate of Coverage for a complete listing of covered benefits and coverage requirements. A summary of covered benefits is provided.

Physician and professional provider services
Second surgical opinion
Home Health Care up to 120 days in a calendar year
Hospice Care
Inpatient and outpatient hospital services
Well Child Care /Early and Periodic Screening/Diagnosis and Treatment
Immunizations
Skilled Nursing Facility up to 120 days per admission
Chiropractic Care
Acupuncture Therapy
Physical, Speech, and Occupational therapy
Durable Medical Equipment
Prosthetic and Orthotic appliances, including shoe inserts when prescribed by a physician
Organ and Tissue Transplants
Hearing Care
Vision Care
Prescription medications
Weight Loss counseling
Care at a Federally Qualified Health Center (FQHC), Tribal Health Center, Rural Health Centers, and Child and Adolescent Health Centers.
Medically Necessary pregnancy terminations or in the case of rape or incest
Tobacco cessation services

BENEFIT LIMITATIONS AND EXCLUSIONS

There are certain things that are not paid for by your plan. We refer to these services as not covered benefits. There are some things that have “limits.” This means there are conditions that must be met in order to have something covered. Or, it could mean that we cover things up to a certain point or “limit.“

A summary of "limitations" and "exclusions" are provided. Please refer to your Certificate of Coverage for a complete list of exclusions and limitations.

LIMITATIONS:

Dental/Oral Health Services are limited to:

Oral screening with a referral to a dental provider as appropriate
Oral health care, diagnostic services, treatment, or services necessary to correct or improve defects, physical illnesses, and conditions discovered during a screening
Relief of pain and infections.
Fluoride Varnish Treatments 4 times in a period of 12 consecutive months for members age 0-3 years.
Obstetrical deliveries in a home.

Oral Surgery is limited to:

The treatment of a jaw fracture, dislocation, or wound
The treatment of cysts tumors, or other disease tissues
Other surgical procedures on gums and tissues of mouth when it is not done as part of a tooth repair or tooth removal
Medically necessary jaw surgeries
Office visit charges related to the above services

EXCLUSIONS:

Services that are not authorized by your GVHP Family Health Center
Services out-of-area that are not authorized by your GVHP Family Health Center; this does not mean emergency care
Investigational and experimental procedures
Services, equipment, and supplies that go along with experimental or investigational procedures
Services that are not medically necessary
Services that are not considered generally accepted medical practice
Office visits, examinations, treatment, tests and reports for are needed to document health or medical status for employment, insurance, travel, or legal proceedings
Elective cosmetic surgery
Comfort items and items not medical in nature
Behavioral (mental) health counseling/substance abuse service – *To receive services contact your local community mental health agency.
Routine dental service – *See your Dental healthcare plan.
Court-related services
Special elective procedures; some examples include voluntary pregnancy termination, radial keratotomies
Services that go along with non-covered benefits
Services provided by a school district
Dental implants and prosthesis
Reproductive procedures; like in-vitro fertilization, GIFT and ZIFT
Services to treat educational, developmental or learning disabilities
Rehabilitation services, cognitive therapy, vocational training and driver’s training
Lost wages
Implantable hearing devices
Food supplements and formula
Routine foot care
Obstetrical deliveries in a home.

For additional information see your GVHP MIChild Certificate of Coverage.