Blue Cross and Blue Shield Service Benefit Plan.
2007 Service Benefit Plan Benefit Changes.
This page provides a summary of the benefit changes for 2007. For a complete description of benefits please refer to Section 2 of the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure (RI 71-005) online or you can call your local Blue Cross and Blue Shield Plan at the number on the back of your ID card to request one.
Click on the links that follow or scroll down to learn about Service Benefit Plan benefit changes in 2007.
Standard Option And Basic Option Benefit Changes.
The states designated as medically underserved areas have changed. For 2007 Texas has been added to this list of medically underserved areas and Alaska has been removed. See Section 3 of the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for more information about these areas.
We also now provide preventive care benefits for Herpes Zoster (shingles) and Human Papillomavirus (HPV) vaccines as licensed by the Food and Drug Administration (FDA) for adults. We also provide preventive care benefits for children who receive Rotavirus vaccines and HPV vaccines. See Section 5(a) of the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for additional information about benefits for these vaccines.
In 2007, benefits are available for implanted penile prostheses to treat erectile dysfunction regardless of its physiological cause. In the past, benefits were provided for this prosthesis under limited circumstances.
We have expanded our Provider Directory to provide information you need to make better health care decisions.
• Through the Review Hospital Profiles link on the provider directory data page, you can compare information on the number of patients treated for a specific condition or procedure at specific hospitals, complication rates related to the condition or procedure, and the average length of stay for the condition or procedure. You can also review the percentage of patients who died while being treated at the hospital, or the mortality rate of the hospital as well as the hospital's compliance with the patient safety standards developed by the Leapfrog Group.
• You can also get information about what your care will cost through the Review Cost Information link on the provider directory data page. This cost estimator provides an estimate of the cost for a course of treatment for a specific condition or procedure.
• You can continue to check out the cost of prescription drugs by accessing the Check Drug Cost tool on the Caremark web site accessed through Pharmacy Programs.
We are pleased to announce national Blue Distinction Centers for Cardiac CareSM and Bariatic SurgerySM. These Centers join the Blue Distinction Centers for TransplantsSM (formerly Blue Quality Centers for Transplant) now available to our members. Please check out the information under the To Your Health feature for more information about these Centers.
As you may know, your out-of-pocket costs may be limited when you use Non-participating providers. The description and amount of the limit have changed for 2007. Please read the definition of Plan Allowance in the Definitions Section of the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for more specific information.
We also have clarified benefits for 2007 concerning diagnostic tests. Standard Option and Basic Option benefits are not available in 2007 or in previous years for diagnostic tests performed by mobile vans when the tests are not requested by a physician.
Standard Option Only Benefit Changes.
Under Standard Option, the following benefit changes are effective January 1, 2007:
• Currently, benefits for professional visits for the treatment of mental conditions and substance abuse are limited to two hours per visit. In 2007, the two hour visit limit is eliminated. Please see Section 5(e) in the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for additional information.
• Benefits for covered ambulance services are currently paid in full, after a 10 percent coinsurance amount, when you use a Preferred, Participating or Member ambulance provider. You also pay a 10 percent coinsurance amount if you use Non-participating or Non-member ambulance providers, however you are also responsible for any difference between our allowance and the billed amount. For 2007, benefits for covered ambulance transportation are provided in full, after a $50 co-payment. Please see Sections 5(c) and 5(d) in the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for more information about ambulance benefits.
• We are increasing the number of chiropractic manipulations covered under your Standard Option enrollment from 10 manipulations per calendar year per person to 12 manipulations per calendar year per person. For more information about chiropractic benefits, please see Section 5(a) in the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure.
• We are also increasing the number of visits for acupuncture in 2007 from 10 to 24 visits per calendar year per person. Additional information about benefits for acupuncture can be found in Section 5(a) of the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure.
Basic Option Only Benefit Changes.
We now provide benefits in full for diagnostic or psychological tests billed by the outpatient department of a Preferred, Member or Non-member facility when related to the treatment of a mental health or substance abuse condition. Previously, these services were paid in full, after you paid a $40 co-payment. Please see Section 5(c) of the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for detailed benefit information.