CurrentHighmark DelawarePolicy N/A

SWORD Health Pelvic Health Virtual Program (Bloom) — Coverage Criteria

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Defines coverage, eligibility, and enrollment details for SWORD Health's virtual pelvic health program (Bloom) offering pelvic floor physical therapy via licensed PTs and an insertable sensor, for eligible Highmark Delaware commercial members.

Policy Summary

PayerHighmark Delaware

PolicySWORD Health Pelvic Health Virtual Program (Bloom) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionOffer eligible commercial female members (age ≥18 with vaginal anatomy) enrollment via the My Highmark app or member website; program is provided at no additional member cost.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

61%symptom improvement

49%reduction in utilization

56-58%

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CurrentHighmark DelawarePolicy N/A

SWORD Health Pelvic Health Virtual Program (Bloom) — Coverage Criteria

Customize your policy alerts

Sign up for all Highmark Delaware policy alerts

Know when Highmark Delaware releases new policies or updates existing guidance.

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Policy Summary

PayerHighmark Delaware

PolicySWORD Health Pelvic Health Virtual Program (Bloom) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionOffer eligible commercial female members (age ≥18 with vaginal anatomy) enrollment via the My Highmark app or member website; program is provided at no additional member cost.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

61%symptom improvement

49%reduction in utilization

56-58%

Coverage Criteria

Inclusion Criteria

Covered when ALL of the following are met

Member eligibility: Member is a commercial plan enrollee (limited commercial plans) AND is female (individuals with vaginal anatomy) aged >= 18 yearsage >= 18

Program offered at no additional member cost; sessions do not count against allowed PT visits

Exclusion Criteria

Not covered / excluded when ANY of the following are present

Exclusion conditions: Active cancer treatment; certain neurological, cardiac, or respiratory conditions; high fall risk; inability to bear weight; high-risk pregnancy; within 6 weeks postpartum; first trimester pregnancy; enrolled in a Medicaid/Wholecare plan; enrolled in a Medicare Advantage plan

These members are not eligible for the program

Members are not eligible for the SWORD Health Bloom program and enrollment will be denied when any of the following exclusion criteria are present: receiving active cancer treatment; certain neurological, cardiac, or respiratory conditions; documented high fall risk or inability to bear weight; high‑risk pregnancy, being within 6 weeks postpartum, or being in the first trimester of pregnancy; or when the member is enrolled in a Medicaid/Wholecare plan or a Medicare Advantage plan.

Provider Actions & Enrollment

Prior Authorization

Eligibility & Access — confirm member is eligible commercial enrollee

Offer the Bloom pelvic health program only to eligible commercial plan members: females (individuals with vaginal anatomy) aged 18 years or older who are enrolled in limited commercial plans. The program is offered at no additional member cost and sessions do not count against allowed physical therapy benefit visits.

Member must be female (individuals with vaginal anatomy) aged ≥ 18 years.
Member must be enrolled in eligible limited commercial plans.
Program is free to eligible members with no co-pays/co-insurance and sessions do not count against allowed PT visits.

Step Therapy

When to see a specialist — refer patients needing physician care

Advise patients with pelvic health issues that require physician evaluation or medical management to see their specialist rather than enrolling in the virtual program.

Definitions

Insertable sensor (Bloom Kit)

Device nameBloom Kit insertable sensor

Primary functionMeasures pelvic floor exercises and tracks engagement

FeedbackProvides real-time feedback to the user during exercises

Use settingDesigned for virtual, in-home pelvic floor therapy sessions

SupervisionUsed as part of programs designed and monitored by Pelvic Floor Specialists/licensed physical therapists

Background

SWORD Health's pelvic health program (Bloom) pairs licensed pelvic floor physical therapists with virtual technology and an insertable sensor (the Bloom Kit) to deliver home‑based, personalized pelvic floor rehabilitation. The program is designed to treat pelvic floor disorders and related concerns across pregnancy/postpartum, bowel/bladder dysfunction, menopause‑related issues, and intimacy wellbeing by providing remote monitoring, real‑time feedback from the insertable sensor, and therapist‑led individualized exercise guidance.