Medical Benefits

Your Blue Cross Community Health PlansSM coverage includes many of your health care needs. You pay nothing ($0) when you go to a doctor or health care provider in the plan's network.

Services must be medically necessary. Some services need approval from your health plan before you get treated. This approval is called "preauthorization." Your doctor should know which services need approval and can help with the details.

What is covered?

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

Type of Care
Benefit Limit/Exclusions
Requires preauthorization





Annual Adult Well Exams
Well exam must be done by your Primary Care Provider (PCP) or Women’s Health Care Provider (WHCP)
Behavioral Health Services
Services include:
• Medication management
• Counseling
• Community treatment and support
Yes, under certain circumstances.
Chiropractic Services
Covered for members under age 21
Dental Services*
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
Family Planning Services and Supplies
Services include:
• Doctor visit
• Birth Control
• Family Planning and Education Services that are not included:
• Fertility treatments
• Surgery to reverse sterilization
Home Health Care Services
Services include:
• Home health aide services
• Speech therapy
• Physical therapy visits
Hospital Emergency Room Visits
Go to the nearest hospital in an emergency.
Hospital Inpatient Services and Ambulatory Services
Laboratory and X-ray Services
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
Services include transportation to:
• A doctor’s appointment
• An appointment with another health care provider
You are not required to obtain a prior authorization for standard non-emergency transportation services.
Vision Services

*Some limits apply to general dentistry.

For a complete list of covered services, 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).