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Anthem Blue Cross and Blue Shield |
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Anthem Blue Cross and Blue Shield |
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Plan Description With
Network Blue New England you have the comfort of knowing
that you’re covered in sickness, in health, in the hospital,
and in emergencies, anytime, anywhere. There are no waiting
periods for benefits, no deductibles to meet, and claim
forms to fill out. You’ll be recognized when you
travel as a member of the Blue Cross Blue Shield Family. These
pages highlight some of the benefits of your Network Blue
New England plan. The benefits described are covered
when arranged by your primary care physician and coordinated
by Network Blue New England. Your benefit description and
riders define the terms and conditions of our plan. Should
any questions arise, the benefit description and riders will
govern. Some of the services not covered are: custodial
care; cosmetic surgery; eyeglasses; contact lenses; most
dental care (other than covered pediatric preventive dental
care, provided care is received from a Blue Cross and Blue
Shield participating dentist); chiropractor services;
hearing aids; any services covered by workers’ compensation,
other party liability; or coordination of benefits. Please
note: Blue Cross and Blue Shield of Massachusetts, Inc.
administers claims payments only and does not assume
financial risk for claims. Administered by: Anthem
Blue Cross and Blue Shield in Connecticut
Routine checkups including one gyn exam per
calendar year
Preventive dental care for children underage 12
one visit each 6 months
Short-term rehabilitative therapy-physical,
speech/language, or occupational up to 60 visits
per calendar year
Durable medical equipment such as wheelchairs,
crutches, hospital beds covered up to a maximum
of $1,500 per calendar year
All charges beyond the $1,500 calendar year
benefit maximum
Oxygen and equipment for its administration Inpatient Care
Hospital care as many days as medically
necessary
Surgical services, X-rays and lab tests, and
anesthesia
Care in a skilled nursing facility up to 100
days per calendar year
Care in a rehabilitation facility up to 60 days
per calendar year
At designated retail pharmacies up to a 30-day
supply for each prescription/refill or supply
$10 for generic
Through mail-service drug program up to a 90-day
supply for each prescription/refill or supply
$10 for generic Mental Health and Substance
Abuse Treatment
Biologically-based conditions* Inpatient
admission in a general hospital or mental
hospital
Non-Biologically based mental conditions
(includes drug addiction and alcoholism)
Inpatient admissions in a general hospital
Inpatient admissions in a mental hospital or
substance abuse treatment facility up to 60 days
per calendar year
Nothing
Outpatient visits up to 8 visits in calendar
year
Treatment for rape-related mental or emotional
disorders and treatment for children under the
age of 19 is covered to the same extent as
biologically-based conditions Your
Primary Care Physician:
Your primary care physician
(PCP) is the first person you call when you need medical
care. If your PCP determines that you need to see a
specialist, you’ll be referred to the appropriate specialist
affiliated with your PCP’s network, which is also the
network where you’ll receive inpatient care if needed. Choosing a
Primary Care Physician.
When you join Network Blue
New England, you may choose a PCP for you and each member of
your family from any New England state. You’ll find a
complete listing of PCP’s for each state in the state’s
Provider Directory. In addition to PCP’s each directory
lists specialists, hospitals, and health centers. If you
need a copy of a directory from any New England state, or if
you need help choosing a doctor, call the Physician
Selection Service at 1 800-821-1388. Urgent
Care: If you need
urgent medical care, call your PCP to arrange where you’ll
receive treatment. Examples of urgent care are sprains,
earaches, and high fever. Urgent
Care Away from Home:
If you’re traveling outside
of your plan service area (the state in which your PCP is
located) and you need urgent care, go to the nearest
appropriate medical facility. You or someone on your behalf
must call your PCP within 48 hours and any follow-up care
must be arranged by your PCP. Emergency
care—Wherever You Are:
In an emergency, such as a
suspected heart attack, stroke or poisoning, you should go
directly to the nearest medical facility or call 911 or the
local emergency phone number. There is a $25 co-payment for
emergency room services, which is waived if you’re admitted
to the hospital. You are someone on your behalf should
notify your PCP within 48 hours. Any necessary follow-up
care must be arranged by your PCP. Dependent
and Student Benefits:
Network Blue Network Blue New
England covers our unmarried dependent children until age 19
or full-time students until age 25. Student coverage ends
when the student turns 25, or marries, or on November 1
following the date the student discontinues full-time
classes or graduates, whichever comes first. Living
Healthy Program In
addition to assuring you of access to appropriate medical
care, your Network Blue New England membership helps you
live as healthy a life as possible. For example, you’ll
receive our booklet Living Healthy Programs, which
outlines how to take advantage of many special programs,
available to you—such as discounts on products and services
that promise good health and a safer home environment.
Living
Health Babies No Charge A Fitness
Benefit toward membership at any health club you choose
You receive $150 per year per individual/family Discounts on
eyewear, frames, lenses, supplies, safety helmets, and home
safety items Discount varies BlueCare Line to answer your
health care questions 24 hours a day No charge Living
Healthy Naturally—discounts for acupuncture, massage
therapy, and nutritional counseling 20% discount |
