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Cosmetic services related to gender reassignment surgery. These covered services may include (but are not limited to): plastic surgery of the nose; face lift; lip enhancement; facial bone reduction; plastic surgery of the eyelids; liposuction of the waist; reduction of the thyroid cartilage; hair transplants; surgery of the larynx; and lip reduction.

(Diabetes management means diabetes evaluation and/or management medical services, diabetic foot care, and/or diabetic eye exams.)

The member's office visit copayment is waived when medical care services are furnished at a hospital (unless the provider's office is located at or professional charges are billed by the hospital).

The member's office visit copayment is waived when medical care services are furnished at a hospital (unless the provider's office is located at or professional charges are billed by the hospital).

The member's office visit copayment is waived when medical care services are furnished at a hospital (unless the provider's office is located at or professional charges are billed by the hospital).

Wellness Benefits - All members may take part of the fitness benefit and weight loss program benefit. For each membership, up to a combined total of $350 each calendar year is reimbursed for fees paid for a health club membership or for fitness classes at a health club and fees paid for hospital-based weight loss programs or for non-hospital-based weight loss programs that are designated by Blue Cross Blue Shield. The member can claim this maximum benefit for any combination of fees incurred by the subscriber and/or other members enrolled under the same family membership. However, each member claiming all or part of the fitness benefit must have paid at least four months health club fees for that calendar year.

Eyewear (prescription eyeglasses or contact lenses) once during the time period described in the benefit limit. These covered services include standard single vision, bifocal, trifocal, or progressive spectacle lenses, and/or frames or contact lenses; plus fittings, dispensing fees and contact lens evaluation.

Transportation and Lodging: This health plan also provides coverage for transportation and lodging costs when the member receives specialty care covered under this program and the member lives more than 100 miles from the Blue Distinction Center. This coverage is available for the recipient (the member) and one companion (or two companions if the member recipient is an enrolled minor dependent child who is receiving specialty care). Any copayment and/or coinsurance do not apply for these covered services. This coverage is limited to:

$200 per day. (Note: Airfare does not count toward this per day maximum).

This health plan includes the Blue Distinction Program. Under this program, covered services for the types of specialty care listed below must be furnished in a Blue Distinction Center in order for the member to receive the maximum health plan coverage.