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PLUS THESE PROFESSIONAL EXPENSES (Cont.)• home healthcare, hospice and skilled nursing care(prior authorization required)• attention deficit and hyperactivity disorder diagnosisand coverage, up to $600 for initial diagnosis• cleft lip and cleft palate services• initial diabetes education up to $500• coverage for hearing aids for children age17 and underPRESCRIPTION DRUG COVERAGEAfter the deductible is met, BlueSaver providescoverage for the allowable charge for prescriptiondrugs as follows:• Plans with 100/80 coinsurance: generic = 100%brand-name = 80%• Plans with 80/60 coinsurance: generic = 80%brand-name = 60%Prescription drugs approved to treat alcohol and/or drugabuse and for the treatment of mental disorders aresubject to the following:• Plans with 100/80 coinsurance: generic = 80%brand-name = 50%• Plans with 80/60 coinsurance: generic = 70%brand-name = 50%Mail-order prescription services are not availableat this time. See our website at www.bcbsla.comfor more information.Members who purchase specialty medications totreat chronic illnesses may now access our SpecialtyPharmacy Network. Contact your agent for details orvisit www.bcbsla.com for more information. Click onCustomer, then Covered Drugs under QUICK LINKS.Specialty drugs are limited to a 30-day supply.Certain exclusions and quantity limits apply.ACCIDENTAL DEATH & DISMEMBERMENTA $10,000 accidental death and dismembermentbenefit is automatically included with this BlueSaverpolicy. Benefits are paid for covered loss of life, limbor sight resulting from an accident.REHABILITATIVE CAREThis benefit provides coverage for inpatient, outpatientand professional services for physical, occupationaland speech therapy. Rehabilitation day programsmay be authorized in place of inpatient stays. Speechtherapy is limited to $2,500 in allowable charges eachbenefit period. Physical and occupational therapiesare limited to $4,500 in combined allowable chargeseach benefit period. These benefits apply to the benefitperiod deductible.PREGNANCY CARE OPTIONThis option provides coverage for pregnancy caresubject to your deductible and coinsurance. The familydeductible applies to all pregnancy and well-babycharges when a newborn is added to subscriber-onlycontracts. Consult your sales representative for details.NOTE: Miscarriages and ectopic pregnancies are covered regardlessof whether you choose the pregnancy option.OUR PPO PROVIDER NETWORK GIVESYOU SAVINGS & THE POWER TO CHOOSEThe PPO network is a select network of preferredprovider organization hospitals, physicians and otherhealthcare providers who have agreed to give our PPOcustomers discounts off their standard charges.ThePPO benefit provides the highest level of benefits whenyou see a PPO network provider. If you use a provideroutside of this network, you receive reduced benefits.To find a preferred doctor or hospital, visitwww.bcbsla.com, click on Find a Doctor or Hospital,then click Online Louisiana Directory and selectPrefered Care PPO.SERVICES NOT COVERED INCLUDEBUT ARE NOT LIMITED TO:• any health conditions, illnesses or diseases listedin an exclusion rider provided by Blue Cross andBlue Shield of Louisiana• cases covered under Workers’ Compensationand employer liability laws• custodial care• treatment for alcohol and/or drug abuse• treatment for mental disorders• diagnostic admissions• corrections for refractive errors of the eye• contraceptive and fertility drugs, regardlessof medical necessity• impotence drugsThis is a partial list. Please see the contract fora complete list of limitations and exclusions.PRE-EXISTING CONDITIONEXCLUSION PERIODThere is a pre-existing condition exclusion period forthe coverage of treatment for pre-existing conditions.That period is 365 days from the effective date ofcoverage. A pre-existing condition is a condition thatwould have caused an ordinary prudent person to seekmedical advice, diagnosis, care or treatment during the365 days prior to the effective date of coverage,a condition for which medical advice, diagnosis,4
care, treatment or a prescribed drug was recommendedor received during the 365-day period prior to theeffective date of coverage or a pregnancy existingon the effective date of coverage. All pre-existingcondition exclusion periods may be reduced for timeserved under a prior plan’s health coverage as perstate and federal guidelines.VALUE-ADDED SERVICESDiscount FeaturesAs an extra value, all covered members may receiveinstant discounts from our special network of vision,hearing and dental providers. We’ve negotiated withthese providers to give our covered members significantsavings on these services. Since this is a discount-onlyprogram and not a policy benefit, covered membersenjoy immediate savings at the point of service and donot have to file claims or wait for reimbursement!To find a participating provider, visit www.bcbsla.com,click on Find a Doctor or Hospital on the homepage, then Online Louisiana Directory, then selectDiscount Dental, Vision and Hearing.Benefits that TravelThe BlueCard ® Program – When our members travel,they take their healthcare benefits with them –across the country and around the world. BlueCard ®is a national program that allows our members toreceive healthcare services while traveling or livingin another Blue Plan’s service area. The programlinks participating healthcare providers with theindependent Blue Plans across the country and in morethan 200 countries and territories worldwide, througha single electronic network. Our members have peace ofmind knowing they’ll find the care they need if they getsick or injured on the road.It’s easy for members to access a provider outsideof their service area:• They can visit the BlueCard Doctor and Hospital Finderwebsite at www.bcbs.com/coverage/bluecard; or• Call the BlueCard Access line at 1.800.810.BLUE.CUSTOMER SERVICEYour Answer is Just a Click or a Call Away…Have a question about your claim? Want to know ifa service is covered under your plan? Get the answersto your healthcare questions using our new, secureonline Customer Inquiry Form.This form allows you to submit questions toour Customer Service Department securely andconveniently – any time of day or night. Simply logon to the Blue Cross website at www.bcbsla.com,click on Customer, then choose Customer Inquiry Form.Follow the directions on the screen to get started!You can always call us between 8 a.m. and 5 p.m.,Monday through Friday, at 1.800.495.BLUE (2583).This number is also listed on your member ID card.5
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