HIRSP Federal Plan - Covered Services
HIRSP Federal Plan will cover medically necessary and appropriate services consistent with the HIRSP Federal policy. Prescription drugs must be obtained at a HIRSP-certified network pharmacy. A partial listing of covered services follows.
Covered Services
- $150 of first dollar coverage for routine and preventive services
- Medical-surgical services
- Anesthesia services
- Consultation
- Prescription drugs
- Home Care
- Radiology services
- Laboratory services
- Pap test and pelvic exam
- Prostate cancer screening
- Skilled nursing care
- Hospice care
- Services and supplies for treatment of diabetes
- Yearly routine exam
Covered Services Requiring Prior Approval
- Durable medical equipment costing more than $1,500 or rented for more than three months
- Transplant services
- Home Intavenous (IV) therapy or home infusion therapies including Total Parenteral Nutritional (TPN) and antibiotic therapy
- Prosthetics costing more than $1,500
- Surgical Services for morbid obesity
- Reduction mammoplasty, septoplasty, and blepharoplasty
- Spinal surgeries*
- PET scans*
- MRA studies*
- Dental repair related to an injury*
- Inpatient non-emergency admissions, at least 3 business days prior to confinement
- Outpatient visits and transitional treatment for treatment of alcoholism, drug abuse and nervous or mental disorders beyond 50 visits per calendar year
- Pain management procedures, including injections
- Spinal cord stimulator
- Implantable infusion pain pump
- Genetic testing services for treatment of an illness
- * Prior approval not required in the event of an emergency
- Prior Approval Request Form