The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
Transplants
Coverage for transplants is limited to human organ or tissue transplants that are not
experimental, investigative or unproven, including bone marrow, kidney, cornea, heart, lung(s),
or heart and lung(s), liver, and pancreas if in conjunction with a kidney transplant. There is no
coverage for artificial organs, transplantation of animal organs and/or tissue, and all services and
supplies related to artificial or non-human organ implants. Contact BCBS for information about
living donor transplant coverage.
All transplants must be performed at a participating transplant center associated with BCBS.
Services performed at non-participating transplant centers are not covered even if the
services are medically necessary and/or referred. Other benefit limits and restrictions
apply.
All transplants, except cornea and kidney transplants, must be received at a Blue Distinction
Centers for Transplants ® . A BCBS Transplant Coordinator will authorize and coordinate your
care and assist you with travel and lodging reimbursement. Contact a BCBS Transplant
Coordinator at 651-662-9936 or 866-309-6564. You may view a listing of designated transplant
centers at www.bluecrossmn.com/usb.
Expenses for Travel and Lodging
Except for cornea and kidney transplants, expenses for travel and lodging for the transplant
recipient and a companion are available as follows:
• Transportation of the patient and one companion who is traveling on the same day(s) to
and/or from the site of the transplant for the purposes of an evaluation, the transplant
procedure or necessary post-discharge follow-up.
• Reasonable and necessary expenses for lodging for the patient (while not hospitalized) and
lodging only for one companion. Expenses are reimbursed at a per diem rate of up to $50 for
one person or up to $100 for two people.
• Travel and lodging expenses are available only if the transplant recipient resides more than
50 miles from the designated transplant facility.
• If the patient is a covered dependent minor child, the transportation expenses of two
companions will be covered and lodging expenses will be reimbursed up to the $100 per
diem rate.
There is a combined overall lifetime maximum of $10,000 paid by the plan per covered person
for all transportation and lodging expenses incurred by the transplant recipient and companion(s)
and reimbursed under this plan in connection with the transplant. Note: The deductible must be
met by members enrolled in the Early Retiree Medical option before these expenses can be
reimbursed by the Program.
Non-Custodial and Full-Time Student Dependents Under the Early Retiree
Medical Option
If you are required by law to maintain health care coverage for a dependent (under age 18) who
lives outside your state or network service area or if you have an eligible dependent attending
school full-time outside your state or network service area, your dependent may choose an
eligible BCBS BlueCard PPO network provider in the location where your dependent resides.
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