52 • It has been determined that the covered individual is at risk for carrier status as supported by existing peer-reviewed, evidence-based, scientific literature for the development of a genetically linked inheritable illness when the results will impact clinical outcome; or • The therapeutic purpose is to identify specific genetic mutation that has been demonstrated in the existing peer-reviewed, evidence-based, scientific literature to directly impact treatment options. Home Health Care The following charges for Home Health Care services are covered medical charges. The Plan will not pay for Home Health Care unless: • A plan of Home Health Care is drawn up, or approved, by the covered individual’s physician; and • The physician certifies that: − Home Health Care is Medically Necessary; and − In the absence of Home Health Care, the covered individual would be an inpatient at an Acute Care Hospital; or • A Quantum Health case manager recommends Home Health Care services as being the most appropriate treatment in the most effective setting possible for the patient’s medical condition. Home Health Care charges include: • Charges for the services of a home health aide on a part-time or intermittent basis. Services under this benefit are limited to 40 visits in a calendar year. Note: The Plan will not pay for visits that exceed the 40-visit limit. One home health aide visit is limited to four hours or less. • Charges for nutrition counseling. • Charges for psychiatric treatment by a licensed social worker who is practicing within the scope of the license. • Practitioner charges and medical support charges. Hospice Care Charges for Hospice Care by a Hospice Care Program or other qualified Hospice Care provider as listed below are covered medical charges under the terms of the Plan. Charges that are incurred only: (a) during a period (no longer than 6 months) for which the Claims Administrator validates a physician’s certification that the participant is a terminally ill patient, and (b) during the bereavement period, will be covered under the terms of the Plan. Covered Hospice Care charges include the following, if provided by a Hospice Care Program: • Confinement of the terminally ill participant as an inpatient in a Hospice Care facility. • Home Health Care furnished to the terminally ill participant in his or her home. Such Home Health Care may include, as part of Hospice Care: − Services of a home health aide. − Professional services of a Nurse. − Physical therapy or other therapy furnished by an Allied Health Professional.