Claim limits and changes to the IHC Policy will be determined annually by the County IHC Board. Most services will be reimbursed at the 77% ratio, except for in-patient hospital services, physician reimbursement, and oxygen services through the participating Home Health Provider. There is a $100 billed amount limitation. There is a $15,000 fiscal year limit for hospital services and a $5,000 fiscal limit for ambulance service. (This is per patient and amounts can not be transferred from one patient to another.)
Primary Care Services to an eligible individual will be subject to a limit of $4,000 per patient per fiscal year. (Primary Care co-pays are not eligible because they are considered reasonable and generally result after the Medicare reimbursement.)
The limit for Substance Abuse is one in-patient treatment per fiscal year up to $9,000. Limit for Mental Abuse (includes suicide claims) is $10,000 per fiscal year.
Limit for pregnancy related treatment is $10,000 and only one pregnancy is allowable per patient.
Home Health Services are limited to $9,000 per fiscal year.
Hospice treatment has a limit of $9,000 per patient per fiscal year.