Guam § 9402 - Same: Mandatory Benefits and Optional Services.

§ 9402. Same: Mandatory Benefits and Optional Services.

(a) Mandatory benefits under this Chapter applying to Prepaid Health Plans, shall include:

(1) Out-patient services which are covered as follows: physicians; hospital out-patient;

optometric; acupuncture; podiatric; physical therapy; and audiology, insofar as these can be

encompassed by Federal participation under an approved plan;

(2) Hospital in-patient care;

(3) Nursing home care (when available in Guam), including physician services and prescription

drugs;

COL 2025-04-22

(4) Purchase of prescription drugs prescribed by a physician for the treatment of all medical

conditions at a nominal charge;

(5) Hospital out-patient dialysis services and home hemodialysis services, including physician

services, medical supplies, drugs and equipment required for dialysis;

(6) Out-patient laboratory and out-patient x-ray services;

(7) Blood and blood derivatives;

(8) Dental services;

(9) Preventive services (physical examinations, well baby care, immunizations and injections);

(10) Basic dental services (examination, prophylaxis, x-rays, routine fillings and extractions,

emergency treatment);

(11) Emergency care on and off-island (including ambulance);

(12) Durable medical equipment and medical supplies;

(13) Other diagnostic screening or preventive services.

(b) Optional Services shall include:

(1) Eyeglasses;

(2) Comprehensive dental care (dentures, crown and bridgework, root canal, etc.);

(3) Home health care;

(4) Prosthetic devices and hearing aids;

(5) Out-patient services including chiropractic, psychology, occupational therapy, speech

therapy.

(c) For providers who are not Prepaid Health Plans, the benefits of Subdivision (a)(6) shall apply, but

such benefits shall be subject to the following limitations:

(1) Nursing home care shall be limited to one hundred twenty (120) days per benefit period;

(2) Prescription drugs shall be excluded, except those required for long-term treatment of chronic

disease;

(3) Cosmetic surgery shall be excluded unless approved by psychiatric consultation or vocational

rehabilitation agency and related employment.

(d) Services to be provided by the government of Guam through the Department of Public Health and

Social Services, shall include:

(1) Speech, occupational and audiology therapy;

(2) Rehabilitative services;

(3) Psychiatric care; and

(4) Long-term treatment of infectious disease.