Blue Choice HMO Benefits - Harford County Public Schools

B. Covered Services
1. An annual routine Chlamydia Screening Test for:
a. Female Members who are under the age of 20 years if they are sexually
active; and at least 20 years old if they have Multiple Risk Factors.
b. Male Members who have Multiple Risk Factors.
2. A Human Papillomavirus Screening at the testing intervals outlined in the
recommendations for cervical cytology screening developed by the American
College of Obstetricians and Gynecologists.
2.16 Osteoporosis Treatment Services.
A. Benefits are available for Bone Mass Measurement for the diagnosis, and treatment of
Osteoporosis when the Bone Mass Measurement is requested by a Health Care Provider
for the Qualified Individual.
B. Bone Mass Measurement means a radiologic or radioisotopic procedure or other
scientifically proven technology performed on a Qualified Individual for the purpose of
identifying bone mass or detecting bone loss.
C. Qualified Individual means:
1. An estrogen deficient individual at clinical risk for osteoporosis;
2. An individual with a specific sign suggestive of spinal osteoporosis, including
roentgenographic osteopenia or roentgenographic evidence suggestive of collapse,
wedging, or ballooning of one or more thoracic or lumbar vertebral bodies, who is a
candidate for therapeutic intervention or for an extensive diagnostic evaluation for
metabolic bone disease;
3. An individual receiving long-term glucocorticoid steroid therapy;
4. An individual with primary hyperparathyroidism; or
5. An individual being monitored to assess the response to or efficacy of an approved
osteoporosis drug therapy.
2.17 Treatment for Cleft Lip or Cleft Palate or Both. Benefits will be provided for inpatient or
outpatient expenses arising from orthodontics, oral surgery, otologic, audiological and
speech/language for cleft lip or cleft palate or both.
2.18 Cardiac Rehabilitation. Cardiac Rehabilitation benefits are provided to Members who have
been diagnosed with significant cardiac disease, as defined by CareFirst BlueChoice, or, who
have suffered a myocardial infarction or have undergone invasive cardiac treatment immediately
preceding referral for Cardiac Rehabilitation, as defined by CareFirst BlueChoice. Coverage is
provided for all Medically Necessary services, as determined by CareFirst BlueChoice. Services
must be provided at a CareFirst BlueChoice approved place of service equipped and approved to
provide Cardiac Rehabilitation.
1. Benefits will not be provided for maintenance programs.
2. Covered Cardiac Rehabilitation services are not subject to referral or utilization
management requirements, if treatment is received from a Contracting Provider.
MD/GHMSI/CFMI BC (R. 10/10)
CareFirst BlueChoice
Harford County Public Schools 16 7/1/2011