BlueCare Direct with Advocate


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BLUECARE DIRECTSM

Blue Care Direct HMO

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Chicago-area residents now have a new choice for health care coverage. Blue Cross and Blue Shield of Illinois (BCBSIL) has teamed up with Advocate Health Care* to offer a new, more affordable health plan — BlueCare Direct.

BlueCare Direct. Great Access. More Affordable Coverage.

BlueCare Direct combines the strength, expertise and reputation of two of the state’s most respected leaders in the health industry. Advocate is the largest health system in Illinois, and BCBSIL is the largest health insurer in the state. Advocate is uniquely positioned to deliver quality patient outcomes, while working to manage overall health care costs, with the goal of delivering value to our members.

BlueCare Direct provides access to Advocate Health Care’s vast network of doctors and hospitals in Cook, DuPage, Kane, Lake and Will counties. It’s being offered to our individual, family and small group customers on our website. Along with all the features of an HMO, BlueCare Direct offers:

  • Lower monthly premiums and lower out-of-pocket costs than most other HMO plans available to individual plan members
  • Same-day appointments for primary care**
  • Self-refer to specialists within the Advocate network without a PCP referral (except in some instances such as for surgical procedures or physical therapy regimens)
  • Same day mammograms, and get the results on the same day**
  • See a cardiologist within 24 hours
  • Access to Advocate’s network of over 250 sites of care, including:
    • 4,000+ Advocate doctors
    • 11 Advocate community hospitals
    • The state’s largest integrated children’s network
    • The state’s largest home health and hospice companies
    • One of the region’s largest medical groups

BlueCare DirectSM is a unique product that combines the strength, expertise and reputation of two of the state’s leading health organizations. It provides health care coverage that gives members access to the resources of the largest health care system in Illinois, including:

Advocate Direct Hospital Network

  • More than 4,000 Advocate primary care and specialty physicians across Cook, DuPage, Lake, Kane and Will counties
  • 10 Advocate hospitals, including Advocate Children’s Hospital with campuses in Park Ridge and Oak Lawn
  • Advocate Good Shepherd in Barrington
  • Advocate Illinois Masonic Medical Center in Chicago
  • Advocate Trinity Hospital in Chicago
  • Advocate Good Samaritan Hospital in Downers Grove
  • Advocate Sherman Hospital in Elgin
  • Advocate South Suburban in Hazel Crest
  • Advocate Condell Medical Center in Libertyville
  • Advocate Christ Hospital Medical Center and Advocate Children’s Hospital in Oak Lawn
  • Advocate General Hospital and Advocate Lutheran General Children’s Hospital in Park Ridge
  • Advocate’s home health and hospice agency for transition from hospital to home

Because of its Advocate-exclusive network, BlueCare

BlueCare Direct is ideal for your customers who live and work in the greater Chicago area and have no need to pay more for a network that includes providers in other parts of the state.

 

BlueCare Direct with Advocate

BlueCare Direct Bronze 401 with Advocate

Important Questions Answers Why this Matters:
What is the overall deductible?Individual:
Participating $7,400
Family:
Participating $17,100
Doesn’t apply to preventive care
& certain copayments.
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
Are there other services covered before you meet your deductible?Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But a
copayment or coinsurance may apply. For example, this plan covers certain preventive services without
cost-sharing and before you meet your deductible. See a list of covered preventive services at
www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services? NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan?Individual: Participating $8,550
Family: Participating $17,100
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family
members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met
What is not included in the out-of-pocket limit? Premiums, balance-billed charges,
and health care this plan doesn’t
cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?Yes. See www.bcbsil.com or call 1-
800-892-2803 for a list of Participating Providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will
pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the
difference between the provider’s charge and what your plan pays (balance billing). Be aware your
network provider might use an out-of-network provider for some services (such as lab work). Check with
your provider before you get services.
Do you need a referral to see a specialist?Yes.This plan will pay some or all of the costs to see a specialist for covered services but only if you have a
referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider

Your cost if you use
a Non-Participating
Provider

Limitations & Exceptions
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$60/visit; deductible does not apply

Not Covered

None
Specialist visit

$85/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge; deductible does not apply

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services
needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

$100/lab, $150/X-Ray;
deductible does not apply

Not Covered

Referral Required.
Imaging (CT / PET scans, MRIs)

$300/test; deductible does
not apply

Not Covered

Referral Required.
If you need drugs to treat your illness or
condition More information about prescription drug coverage is available here.
Preferred generic drugs

10% coinsurance

Not CoveredLimited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies).

Up to a 90-day supply at mail order. Specialty drugs limited to a 30-day supply.

Payment  of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details.

Non-preferred generic drugs

15% coinsurance

Not Covered
Preferred brand drugs

20% coinsurance

Not Covered

Non-preferred brand drugs

30% coinsurance

Not Covered

Preferred specialty drugs

40% coinsurance

Not Covered

Non-preferred specialty drugs

50% coinsurance

Not Covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

$300/visit plus 50%
coinsurance

Not Covered

Referral required.
For Outpatient Infusion Therapy, see your benefit booklet* for details.
Physician/surgeon fees

$150/visit; deductible does not apply

Not Covered

If you need immediate
medical attention
Emergency room care

$1,000/visit plus 50%
coinsurance

$1,000/visit plus 50%
coinsurance

Per occurrence copayment waived upon inpatient admission. None
Emergency medical transportation

50% coinsurance

50% coinsurance

None
Urgent care

$85/visit; deductible does not apply

Not Covered

Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital
stay
Facility fee (e.g., hospital room)

$850/day; deductible does
not apply

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does
not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$60/office visits; deductible
does not apply
50% coinsurance for other outpatient services

$60/office visits; deductible
does not apply
50% coinsurance for other
outpatient services

Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$850/day; deductible does
not apply

$850/day; deductible does
not apply

None
If you are pregnantOffice visits

Primary Care: $60
Specialist: $85; deductible
does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

No Charge; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

$850/day; deductible does
not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge; deductible does
not apply

Not Covered

Referral required.
Rehabilitation services

$70 /visit; deductible does
not apply

Not Covered

Habilitation services

$70/visit; deductible does not apply

Not Covered

Skilled nursing care

$500/day; deductible does
not apply

Not Covered

Durable medical equipment

No Charge; deductible does
not apply

Not Covered

Referral required
Hospice service50% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Children’s eye exam

No Charge; deductible does not apply

Covered

One visit per year. See your benefit booklet* for details.
Children’s glasses

No Charge; deductible does not apply

Covered

One pair of glasses up to age 19 per year. See your benefit booklet* for details.
Children’s dental check-up

Not Covered

Not Covered

None

*For more information about limitations and exceptions, see the plan or policy document here.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Dental Care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Weight loss programs
Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care (Limited to 25 visits per calendar year.)
  • Cosmetic surgery (Only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
  • Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
  • Infertility treatment (covered for 4 procedures per benefit period)
  • Private-duty nursing (With the exception of inpatient private duty nursing)
  • Routine eye care (Adult, 1 visit per benefit period)
  • Routine foot care (Only in connection with diabetes)

 

BlueCare Direct with Advocate

BlueCare Direct Gold 409 with Advocate

Important Questions Answers Why this Matters:
What is the overall deductible?Individual:
Participating $750
Family:
Participating $2,250
Doesn’t apply to preventive care
& certain copayments.
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
Are there other services covered before you meet your deductible?Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But a
copayment or coinsurance may apply. For example, this plan covers certain preventive services without
cost-sharing and before you meet your deductible. See a list of covered preventive services at
www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services? NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan?Individual: Participating $8,550
Family: Participating $17,100
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family
members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met
What is not included in the out-of-pocket limit? Premiums, balance-billed charges,
and health care this plan doesn’t
cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?Yes. See www.bcbsil.comor call 1-
800-892-2803 for a list of Participating Providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will
pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the
difference between the provider’s charge and what your plan pays (balance billing). Be aware your
network provider might use an out-of-network provider for some services (such as lab work). Check with
your provider before you get services.
Do you need a referral to see a specialist?Yes.This planwill pay some or all of the costs to see a specialistfor covered services but only if you have a
referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider

Your cost if you use
a Non-Participating
Provider

Limitations & Exceptions
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$20/visit; deductible does not apply

Not Covered

None
Specialist visit

$40/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge; deductible does not apply

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services
needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

$40/test; deductible does not apply

Not Covered

Referral Required.
Imaging (CT / PET scans, MRIs)

$250/test; deductible does
not apply

Not Covered

Referral Required.
If you need drugs to treat your illness or condition More information about prescription drug coverage is available here.Preferred generic drugs

10% coinsurance

Not CoveredLimited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies).

Up to a 90-day supply at mail order. Specialty drugs limited to a 30-day supply.

Payment  of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details.

Non-preferred generic drugs

15% coinsurance

Not Covered
Preferred brand drugs

20% coinsurance

Not Covered

Non-preferred brand drugs

30% coinsurance

Not Covered

Preferred specialty drugs

40% coinsurance

Not Covered

Non-preferred specialty drugs

50% coinsurance

Not Covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

$300/visit plus 30%
coinsurance

Not Covered

Referral required.
For Outpatient Infusion Therapy, see your benefit booklet* for details.
Physician/surgeon fees

$40/visit; deductible does not apply

Not Covered

If you need immediate
medical attention
Emergency room care

$1,000/visit plus 30%
coinsurance

$1,000/visit plus 30%
coinsurance

Per occurrence copayment waived upon inpatient admission. None
Emergency medical transportation

30% coinsurance

30% coinsurance

None
Urgent care

$40/visit; deductible does not apply

Not Covered

Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital
stay
Facility fee (e.g., hospital room)

$750/day; deductible does
not apply

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does
not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$20/office visits; deductible
does not apply
30% coinsurance for other outpatient services

$20/office visits; deductible
does not apply
30% coinsurance for other
outpatient services

Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$750/day; deductible does
not apply

$750/day; deductible does
not apply

None
If you are pregnantOffice visits

Primary Care: $20
Specialist: $40; deductible
does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

No Charge; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

$750/day; deductible does
not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge; deductible does
not apply

Not Covered

Referral required.
Rehabilitation services

$40 /visit; deductible does
not apply

Not Covered

Habilitation services

$40/visit; deductible does not apply

Not Covered

Skilled nursing care

$500/day; deductible does
not apply

Not Covered

Durable medical equipment

No Charge; deductible does
not apply

Not Covered

Referral required
Hospice service30% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Children’s eye exam

No Charge; deductible does not apply

Covered

One visit per year. See your benefit booklet* for details.
Children’s glasses

No Charge; deductible does not apply

Covered

One pair of glasses up to age 19 per year. See your benefit booklet* for details.
Children’s dental check-up

Not Covered

Not Covered

None

*For more information about limitations and exceptions, see the plan or policy document here.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Dental Care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Weight loss programs
Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care (Limited to 25 visits per calendar year.)
  • Cosmetic surgery (Only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
  • Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
  • Infertility treatment (covered for 4 procedures per benefit period)
  • Private-duty nursing (With the exception of inpatient private duty nursing)
  • Routine eye care (Adult, 1 visit per benefit period)
  • Routine foot care (Only in connection with diabetes)

 

BlueCare Direct with Advocate

BlueCare Direct Silver 212 with Advocate

Important Questions Answers Why this Matters:
What is the overall deductible?Individual:
Participating $3,200
Family:
Participating $9,600
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
Are there other services covered before you meet your deductible?Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But a
copayment or coinsurance may apply. For example, this plan covers certain preventive services without
cost-sharing and before you meet your deductible. See a list of covered preventive services at
www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services? NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan?Individual: Participating $8,550
Family: Participating $17,100
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family
members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met
What is not included in the out-of-pocket limit? Premiums, balance-billed charges,
and health care this plan doesn’t
cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?Yes. See www.bcbsil.comor call 1-
800-892-2803 for a list of Participating Providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will
pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the
difference between the provider’s charge and what your plan pays (balance billing). Be aware your
network provider might use an out-of-network provider for some services (such as lab work). Check with
your provider before you get services.
Do you need a referral to see a specialist?Yes.This plan will pay some or all of the costs to see a specialist for covered services but only if you have a
referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider

Your cost if you use
a Non-Participating
Provider

Limitations & Exceptions
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$30/visit; deductible does not apply

Not Covered

None
Specialist visit

$65/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge; deductible does not apply

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services
needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

$20/test; deductible does not apply

Not Covered

Referral Required.
Imaging (CT / PET scans, MRIs)

$250/test; deductible does
not apply

Not Covered

Referral Required.
If you need drugs to treat your illness or
condition More information about prescription drug coverage is available here.
Preferred generic drugs

No charge after deductible

Not CoveredLimited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies).
Up to a 90-day supply at mail order. Specialty
drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic
drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details.
Non-preferred generic drugs

10% coinsurance

Not Covered
Preferred brand drugs

20% coinsurance

Not Covered

Non-preferred brand drugs

30% coinsurance

Not Covered

Preferred specialty drugs

40% coinsurance

Not Covered

Non-preferred specialty drugs

50% coinsurance

Not Covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

50%
coinsurance

Not Covered

Referral required.
For Outpatient Infusion Therapy, see your benefit booklet* for details.
Physician/surgeon fees

$30/visit; deductible does not apply

Not Covered

If you need immediate
medical attention
Emergency room care

$1,000/visit plus 50%
coinsurance

$1,000/visit plus 50%
coinsurance

Per occurrence copayment waived upon inpatient admission. None
Emergency medical transportation

50% coinsurance

50% coinsurance

None
Urgent care

$65/visit; deductible does not apply

Not Covered

Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital
stay
Facility fee (e.g., hospital room)

$500/visit plus 50% coinsurance

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does
not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$30/office visits; deductible
does not apply
50% coinsurance for other outpatient services

$30/office visits; deductible
does not apply
50% coinsurance for other
outpatient services

Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$500/visit plus 50%
coinsurance

$500/visit plus 50%
coinsurance

None
If you are pregnantOffice visits

Primary Care: $30
Specialist: $65; deductible
does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

No Charge; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

$500/visit plus 50%
coinsurance

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge; deductible does
not apply

Not Covered

Referral required.
Rehabilitation services

$30 /visit; deductible does
not apply

Not Covered

Habilitation services

$30/visit; deductible does not apply

Not Covered

Skilled nursing care

50% coinsurance

Not Covered

Durable medical equipment

No Charge; deductible does
not apply

Not Covered

Referral required
Hospice service50% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Children’s eye exam

No Charge; deductible does not apply

Covered

One visit per year. See your benefit booklet* for details.
Children’s glasses

No Charge; deductible does not apply

Covered

One pair of glasses up to age 19 per year. See your benefit booklet* for details.
Children’s dental check-up

Not Covered

Not Covered

None

*For more information about limitations and exceptions, see the plan or policy document here.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Dental Care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Weight loss programs
Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care (Limited to 25 visits per calendar year.)
  • Cosmetic surgery (Only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
  • Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
  • Infertility treatment (covered for 4 procedures per benefit period)
  • Private-duty nursing (With the exception of inpatient private duty nursing)
  • Routine eye care (Adult, 1 visit per benefit period)
  • Routine foot care (Only in connection with diabetes)