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Hospice benefits are provided only when: the patient has a terminal illness and is expected to live six months or less (as certified by a Physician); and an adult is the primary care person in the home.

This health plan provides world wide emergency coverage. This means that emergency medical services are covered whether the member is in or out of the service area. These emergency medical services may include inpatient or outpatient services by providers qualified to furnish emergency medical care and that are needed to evaluate or stabilize the member's emergency medical condition. The member does not need a PCP referral or approval from Blue Cross Blue Shield before obtaining emergency medical care. (Refer to Inpatient Medical and Surgical Care in a General Hospital for information about inpatient benefits.)

This health plan provides world wide emergency coverage. This means that emergency medical services are covered whether the member is in or out of Massachusetts. These emergency medical services may include inpatient or outpatient services by providers qualified to furnish emergency medical care and that are needed to evaluate or stabilize the member's emergency medical condition. The member does not need approval from Blue Cross Blue Shield before obtaining emergency medical care. (Refer to Inpatient Medical and Surgical Care in a General Hospital for information about inpatient benefits.)

Blue Cross Blue Shield must determine that the member's condition can be reasonably expected to improve significantly within 60 days of the first therapy visit.

Inpatient admissions in a General or Mental Hospital. This includes semiprivate room and board, special services furnished by the hospital and psychiatric care furnished by a Physician (who is a specialist in psychiatry), Psychologist or Clinical Specialist in Psychiatric and Mental Health Nursing.

The member's copayment is waived when the visit is only for immunizations, lab tests and/or x-rays.

Respiratory therapy services furnished by a covered health care provider. Some examples include postural drainage and chest percussion.

Other Covered Services such as:

Amalgam fillings (one filling for each tooth surface each 12 months).

Composite resin fillings on front teeth (one filling for each tooth surface each 12 months).