Hospice Care
Benefits are provided for inpatient and home hospice services for up to six months. Certification of medical necessity must be obtained from Acentra.
Clinical Trial
Benefits are available for medically necessary routine services associated with an approved clinical trial, as defined by the Affordable Care Act (ACA). Routine services include all items and services consistent with coverage provided under the Plan for a qualified individual not enrolled in a clinical trial.
Applicable Plan limitations for out-of-network care apply to routine services in clinical trials.
Utilization management rules and coverage policies for routine care also apply to routine patient care in clinical trials.
Participants must meet all Plan requirements for precertification, registration, and referrals.
Routine services do not include the following: - The cost of the investigational item, device, or service. - Items and services provided solely for data collection and analysis not used in direct clinical management. - Services clearly inconsistent with widely accepted standards of care for a diagnosis. - Costs for travel, lodging, and meals.
An approved clinical trial includes phase I, II, III, or IV trials related to cancer or life-threatening conditions and must be federally funded/approved, conducted under an FDA investigational new drug application, or exempt from this requirement.
Telehealth Provider Visit
Telehealth provider visit benefits cover HIPAA-compliant health care services like diagnosis, consultation, or treatment using interactive audio, video, or other electronic media. These services must be live consultations and cannot be conducted via audio-only phone, email, or fax. Benefits require services to be provided by a network provider or approved vendor and are subject to copayments and possibly deductibles based on coverage options.
Travel Outside the United States
Benefits are provided for covered services received outside the United States through the BlueCard® Worldwide Program. For non-participating providers, claims must be translated to English and converted to U.S. dollars before submission.
Weight Management Program
The Weight Management Program through ActiveHealth is available for participants with a Body Mass Index (BMI) of 30 or more. This 12-month program offers individual counseling over the phone with dietitians, nurses, and fitness experts at no cost to participants.