40 • The definition of medically necessary is:  Deemed to include medical social services and bereavement counseling; and  C hanged to include palliative care, as well as treatment or diagnosis; and  Changed to allow inpatient respite care. In addition, the following special definitions apply to Hospice Care: • Bereavement Counseling is counseling performed by a licensed or certified social worker or licensed pastoral counselor to assist members of the family unit in coping with the death of the terminally ill participant. • Bereavement Period is the 12 - month period that begins on the date of the death of the terminally ill participant. • Family Unit consists of each member of the terminally ill participant’s family. • Medical Social Services include counseling furnished to the terminally ill parti cipant or to the members of the participant’s family unit to assist each family member in coping with the dying process of the terminally ill participant. The counseling may be furnished by a social worker or a pastoral counselor, but only if such person i s licensed and practicing w ithin the scope of the license. • Palliative Care is care that is provided to relieve the symptoms or effects of an illn ess without curing the illness. • Respite Care is care that is given to a terminally ill participant so that members of the family unit may have relief from the stress of caring for the terminally ill participant. • A Terminally Ill Patient is a participant of the Plan whose physician has certified that the participant is: (a) terminally ill, and (b) expected to live six (6) months or less. Laparoscopic Treatment of GERD The Plan provides in - network coverage for treatment of gastroesophageal reflux disease (GERD) using a laparoscopically implanted magnet ic esophageal ring. There is no out - of - network coverage for this benefit. Guidelines for Coverage of Laparoscopically Implanted Magnetic Esophageal Ring The guidelines set forth below provide an overview of the requirements for medically necessary treatmen t of GERD using a laparoscopically implanted magnetic esophageal ring. These guidelines are subject to periodic change without notice, and prior authorization should be obtained through Cigna well in advance when this treatment option is being considered. • The individual has been diagnosed with severe GERD, as documented by endoscopy. If endoscopy is normal, objective evidence of reflux should include at least one of the following:  24 - hour ambulatory esophageal pH monitoring; or  Barium swallow study; and • The individual continues to have chronic GERD symptoms that have been resistant to conservative medical treatment and unresponsive to two or more of the following lifestyle modifications:  Weight loss for overweight or obese patients; or  Avoidance of late meals and/or specific foods that cause heartburn (spicy foods, citrus, fatty foods, chocolate, caffeine, carbonated drinks, alcohol, etc.); or