Common use of Transplant Benefits Clause in Contracts

Transplant Benefits. Special 34 Note: Blue Shield requires prior authorization from Blue Shield's Medical Xx- xxxxxx for all Special Transplant Services. Also, all Services must be provided at a Special Transplant Facility designated by Blue Shield. Please see the Transplant Benefits portion of the Principal Benefits (Covered Services) section in the Evidence of Coverage for important information on this benefit. Facility Services in a Special Transplant Facility $250 per admission plus 30% Not covered Professional (Physician) Services 30% Not covered

Transplant Benefits. Special 34 31 Note: Blue Shield requires prior authorization from Blue Shield's Medical Xx- xxxxxx for all Special Transplant Services. Also, all Services must be provided at a Special Transplant Facility designated by Blue Shield. Please see the Special Transplant Benefits portion for transplant of the Principal Benefits (Covered Services) section human heart, lung, heart and lung in the Evidence of Coverage for important information on this benefitcombination, human bone marrow transplants, pediatric human small bowel transplants, pediatric and adult human small bowel and liver transplants in combination. Facility Services in a Special Transplant Facility $250 per admission plus 30% Not covered Professional (Physician) Services 30% Not covered

Transplant Benefits. Special 34 31 Note: Blue Shield requires prior authorization from Blue Shield's Medical Xx- xxxxxx for all Special Transplant Services. Also, all Services must be provided at a Special Transplant Facility designated by Blue Shield. Please see the Special Transplant Benefits portion for transplant of the Principal Benefits (Covered Services) section human heart, lung, heart and lung in the Evidence of Coverage for important information on this benefitcombination, human bone marrow transplants, pediatric human small bowel transplants, pediatric and adult human small bowel and liver transplants in combination. Facility Services in a Special Transplant Facility $250 per admission plus 30% Not covered Professional (Physician) Services 30% Not coveredcovered Summary of Benefits