Like most health care plans, Blue Advantage, Blue Select and Blue Value have some limitations and exclusions. When your application is approved, and you become a member, you will have access to your benefit booklet online. It will contain detailed information about plan benefits, and a complete list of exclusions and limitations.
The following is a partial list of services, supplies, drugs or charges that are not covered under the above-referenced health care plans.
- Services and supplies deemed not medically necessary
- Services that are investigational in nature or obsolete, including any service, drugs, procedure or treatment directly related to an investigational treatment
- Experimental drugs or any drugs not approved by the Food and Drug Administration (FDA) for the applicable diagnosis or treatment. Note: This exclusion does not apply to certain drugs used in covered phases I, II, III and IV clinical trials or which meet certain criteria – see benefit booklet for more detail.
- Any condition, disease, illness or injury that occurs in the course of employment, if the employee, employer or carrier is liable or responsible for the specific medical charge (1) according to a final adjudication of the claim under a state's workers' compensation laws, or (2) by an order of a state Industrial Commission or other applicable regulatory agency approving a settlement agreement
- Custodial care
- Cosmetic services
- Any services that would not be necessary if a non-covered service had not been received, except for emergency services in the case of an emergency
- Benefits that are provided by any governmental unit except as required by law
- Any condition suffered as a result of any act of war or while on active or reserve military duty
- Palliative, cosmetic or routine foot care
- Adult dental care
- Weight loss/management programs
- Acupuncture and acupressure
- Eyeglasses or contact lenses, except as specifically covered by your health benefit plan
- Routine hearing examinations and hearing aids or examinations for the fitting of hearing aids for adults
- Drugs associated with assisted reproductive technology
- Services primarily for educational purposes including, but not limited to, books, tapes, pamphlets, seminars, classroom, Web or computer programs, individual or group instruction and counseling
- Experimental services including services whose efficacy has not been established by controlled clinical trials, or are not recommended as a preventive service by the US Public Health Service
- Any condition, disease, ailment, injury or diagnostic service to the extent that benefits are provided or persons are eligible for coverage under Title XVIII of the Social Security Act of 1965, including amendments, except as otherwise provided by federal law
- Any conditions that federal, state or local law requires to be treated in a public facility
Your coverage may be canceled by BCBSNC for failure to pay premiums and for false statements on your application, among other reasons. Coverage for dependent children ends at age 26. Members will be notified 30 days in advance of any change in coverage. These pages contain available benefits only. They are not your insurance policy. Your policy is your insurance contract. If there is any difference between these pages and the policy, the provisions of the policy will control.