You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.
You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island, agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0) If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. This agreement provides coverage for health care services that we have reviewed and determined are eligible for coverage. Health care services which we have not reviewed or which we have reviewed and determined are not eligible for coverage are not covered under this agreement. If a service or category of service is not listed as covered, it is not covered under this agreement. Section 3.0 lists the health care services covered under this agreement along with their related exclusions. Section
You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island, agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0) If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines.
You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0) If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: • the assignment of an Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.28 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement. A health care service remains non-covered (excluded) if any of the following occur: • a service is not assigned a CPT or other code; • a service is not approved by the FDA or other governing body; • we do not review a service within six (6) months of the occurrence of one of the events described above; or • we make a determination, after review, not to cover the service under this agreement. Entitlements for payment shall not be more than our allowance, as defined in Section 8.0. All our payments are subject to the terms and conditions outlined in this agreement. Genetic Information This agreement does not limit your coverage based on genetic information. We will not: • adjust premiums based on genetic information; • request or require an individual or family members of an individual to have a genetic test; or • collect genetic information from an individual or family members of an individual before or in connection with enrollment under this agreement or at any time for underwriti...
