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
Co-Pay
Benefit Limit/Exclusions
Requires preauthorization

TYPE OF CARE

CO-PAY

BENEFIT LIMIT/EXCLUSIONS

REQUIRES PREAUTHORIZATION?

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
Services include:
• Medication management
• Counseling
• Community treatment and support
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
You are not required to obtain a prior authorization for standard non-emergency transportation services.
Vision Services
$0
N/A
Yes

*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