Spell of Illness (SOI) (Health Care) Law and Legal Definition

Spell of Illness (SOI) refers to the period taken by medicare rules as the time for which an insured is sick and entitled to receive health insurance benefits. Spell of illness period is calculated by counting the number of days between the admission of an insured patient to a hospital and the discharge day in which the insured is not an inpatient in a hospital or a skilled nursing facility.

The term "spell of illness" with respect to any individual is defined under 42 USCS § 1395x (a) as a period of consecutive days:

(1) beginning with the first day (not included in a previous spell of illness) (A) on which such individual is furnished inpatient hospital services, inpatient critical access hospital services or extended care services, and (B) which occurs in a month for which he is entitled to benefits under part A [42 USCS §§ 1395c et seq.], and

(2) ending with the close of the first period of 60 consecutive days thereafter on each of which he is neither an inpatient of a hospital or critical access hospital nor an inpatient of a facility described in section 1819(a)(2) [42 USCS § 1395i-3 (a)(2)] or subsection (y)(1).