Medical Benefits

As a Blue Cross Community Health Plans member, you have access to medical, dental, vision, behavioral health, prescription drug coverage and more. Some special benefits include:

  • Zero co-pays: You pay nothing ($0) when you go to a doctor or health care provider in the plan's network.
  • 24/7 Nurseline: If you have questions, our nurses have answers. This help line is staffed all day, every day  with registered nurses. If you have an unexpected medical situation, call the Nurseline at 1-888-343-2697. A nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem at home.
  • Blue365®: Save money on health and wellness products and services through this online discount program. Sign up for email alerts to see new offers.

What is covered?

Here are just some of the services covered under this plan:

Type of Care
Co-Pay
Benefit Limit/Exclusions
Requires preauthorization

TYPE OF CARE

CO-PAY

BENEFIT LIMIT/EXCLUSIONS

REQUIRES PRIOR AUTHORIZATION?*

Annual Adult Well Exams
$0
Well exam must be done by your Primary Care Provider (PCP) or Women’s Health Care Provider (WHCP)
No
Behavioral Health Services
$0
Some services include:
• Alcohol or drug treatments
• Care during a hospital stay
• Outpatient behavioral health services
• Mobile Crisis Response services
Yes, under certain circumstances.
Chiropractic Services
$0
Covered for members under age 21
No
Dental Services
$0
Services include:
• Routine Exams
• Cleanings
• Fillings
• Root canals
• Dentures
• Extractions
Yes, under certain circumstances, a Prior Authorization is required for non-covered benefits.
Emergency and Urgent Care Services
$0
No
Family Planning Services and Supplies
$0
Services include:
• Doctor visit
• Birth Control
• Family Planning and Education

Services that are not included:
• Fertility treatments
• Surgery to reverse sterilization
No
Home Health Care Services
$0
Services include:
• Home health aide services
• Speech therapy
• Physical therapy visits
Yes
Hospital Emergency Room Visits
$0
Go to the nearest hospital in an emergency.
No
Hospital Inpatient Services and Ambulatory Services
$0
Yes
Laboratory and X-ray Services
$0
Services include:
• All medically necessary lab services
• Cancer tests
• X-ray services
Yes, these services must be ordered by your PCP.
Non-emergency Transportation Services
$0
Services include transportation to:
• A doctor’s appointment
• An appointment with another health care provider
• BCCHP sponsored events
You are not required to obtain a prior authorization for standard non-emergency transportation services.
Vision Services
$0
Services include:
• One (1) eye exam every 12 months per member
• Eye glasses:
      • Every two (2) years for
         member age 21 and older
      • Replaced "as needed" for
         members under 21
      • Additional reimbursement
         toward a pair of upgraded
         eyeglass frames
• Contact lenses when medically necessary
Yes

*Services must be medically necessary. Some services need approval from your health plan before you get treated. This approval is called "prior authorization." Your doctor should know which services need approval and can help with the details.
Some limits apply to general dentistry.

For a complete list of covered services and to learn about coverage decisions, see the Member Handbook.

What is not covered?

Some services that are not covered include:

  • Cosmetic surgery or treatment that are not medically necessary
  • Procedures that are still being tested or experimental
  • Services by non-licensed providers
  • Drugs and supplies without a prescription
  • Acupuncture
  • Services in an emergency room for health issues that are not emergencies

Coverage Decisions

Blue Cross Community Health Plans has strict rules about how decisions are made about your care. Our doctors and staff make decisions about your care based only on need and benefits. There are no rewards to deny or promote care. Blue Cross Community Health Plans does not encourage doctors to give less care than you need. Doctors are not paid to deny care.

If you want to know more about the utilization management process or how decisions are made about your care, contact Member Services at 1-877-860-2837 (TTY/TDD 711).