*Applicants must meet all eligibility requirements and qualify for coverage.
**Preventive services are those services performed for screening purposes when the member does not have active signs or symptoms of a condition but do not include diagnostic tests performed because the member has a condition or an active symptom of a condition. Whether something is preventive is determined by the combination of procedure and diagnosis codes submitted by the provider. Except for mammography, foreign travel immunizations, and routine vision exams for members under age five, preventive services are covered only at network providers.
tPlans do not cover all health care expenses and have exclusions and limitations. All plans generally exclude coverage for services, medications, and supplies that are experimental, investigational, cosmetic, for treatment of sexual dysfunction, or which BCBSAZ deems not medically necessary. PPO plans cover only complications of pregnancy and exclude routine maternity. All plans require precertification for inpatient surgery, specialty injectable and certain other medications.
All plans impose member cost share requirements. Depending on the plan, cost share may include copays, access fees, deductibles and coinsurance in percentages that vary based on plan type, deductible level, provider’s status, and benefit type.