For Providers: Medicare Plus Blue PPO Enhanced Benefit Policies

These documents provide information about our Medicare Plus Blue℠ PPO plans for individuals and groups in our enhanced benefit policies. The policies are separated into three versions: active, archived and retired.

Active

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Adult diapers and incontinence liners, PPO only

Information about adult diapers and incontinence liners for PPO members only

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Annual physical examinations, PPO only

Annual physical examinations information for PPO members only

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Bathroom safety items, PPO only

Information about bathroom safety items for PPO members only

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Blood and blood components, PPO only

Information about blood and blood components for PPO members only

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Chiropractic care, PPO group

Chiropractic care information for PPO group members

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Chiropractic care, PPO Individual

Chiropractic care information for PPO Individual members

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Contraceptive devices, PPO only

Information about contraceptive devices for PPO members only

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Determination of refractive state, PPO only

Determination of refractive state for PPO members only. This is necessary for obtaining glasses and includes specification of lens type.

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Emergency department care, PPO only

Emergency department care information for PPO members only

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Foreign travel: Nonemergent, nonurgent care, PPO only

Foreign travel: Nonemergent, nonurgent care for PPO members only. This information is for care outside of the United States or its territories for non-emergency and non-urgent medical care.

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Full body skin examination, PPO only

Information about full body skin examinations for PPO members only

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Gradient compression stockings, PPO only

Gradient compression stockings information for PPO members only

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Hearing services, PPO only

Hearing services for PPO members only

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Home infusion therapy, PPO only

Home infusion therapy information for PPO members only

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Hospice care, PPO only

Information about hospice care for PPO members only

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Human organ transplant, PPO only

Information about human organ transplant for PPO members only

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Inpatient hospital care, PPO only

Inpatient hospital care information for PPO members only

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LASIK, radial keratotomy, PPO only

Information about LASIK and radial keratotomy for PPO members only

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Online visits, PPO only

Information about online visits for PPO members only

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Private duty nursing, PPO only

Information about private duty nursing for PPO members only

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Remote patient monitoring, PPO only

Information for remote patient monitoring for PPO members only

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SilverSneakers® fitness, PPO only

Information about the SilverSneakers® fitness program for PPO members only

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Skilled nursing facility, PPO only

Skilled nursing facility information for PPO members only

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State Health Plan MA acupuncture

Information about acupuncture for State Health Plan MA members

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State Health Plan MA behavioral health substance abuse IOP

Information about behavioral health substance abuse IOP for State Health Plan MA members

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State Health Plan MA continuous blood glucose monitors

Information about continuous blood glucose monitors for State Health Plan MA members

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State Health Plan MA orthopedic shoes and orthotic shoe inserts

Information about orthopedic shoes and orthotic shoe inserts for State Health Plan MA members

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State Health Plan MA preventive care services

Information about preventive care services for State Health Plan MA members

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State Health Plan MA self-administered drugs

Information about self-administered drugs for State Health Plan MA members

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State Health Plan MA TMJ dysfunction treatment

Information about TMJ dysfunction treatment for State Health Plan MA members

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Travel and lodging, PPO only

Travel and lodging information for PPO members only

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UAW Retiree Medical Benefits Trust 5th level hospice care, PPO only

Information about 5th level hospice care for UAW Retiree Medical Benefits Trust PPO members only

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Wigs, PPO only

Information about wigs for PPO members only

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Worldwide coverage - emergency and urgent care, PPO only

Information about worldwide coverage for emergency and urgent care for PPO members only

Archived

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Adult diapers and incontinence liners, PPO only

This is the archived version for Information about adult diapers and incontinence liners for PPO members only

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Annual gynecological exam, PFFS only

This is the archived version for Information about annual gynecological exams for PFFS members only

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Annual gynecological exam, PPO only

This is the archived version for Information about annual gynecological exams for PPO members only

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Annual physical examinations, PFFS only

This is the archived version for Information about annual physical exams for PFFS members only

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Annual physical examinations, PPO only

This is the archived version for Information about annual physical exams for PPO members only

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Bathroom safety items, PPO only

This is the archived version for Information about bathroom safety items for PPO members only

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Blood and blood components, PFFS only

This is the archived version for Information about adult diapers and incontinence liners for PPO members only

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Blood and blood components, PPO only

This is the archived version for Information about blood and blood components for PPO members only

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Chiropractic care, PPO group

This is the archived version for Information about chiropractic care information for PPO group members

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Chiropractic care, PPO individual

This is the archived version for Information about chiropractic care information for PPO individual members

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Contraceptive devices, PPO only

This is the archived version for Information about contraceptive devices for PPO members only

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Dental care, PPO only

This is the archived version for dental care information for PPO members only

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Determination of refractive state, PPO only

This is the archived version for information about determination of refractive state for PPO members only. This is necessary for obtaining glasses and includes specification of lens type.

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Emergency department care, PPO only

This is the archived version for emergency department care information for PPO members only

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Foreign travel: Nonemergent, nonurgent care, PPO only

This is the archived version for Information about adult diapers and incontinence liners for PPO members only

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Full body skin examination, PPO only

This is the archived version for Information about full body skin examinations for PPO members only

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Gradient compression stockings, PPO only

This is the archived version for Information about gradient compression stockings for PPO members only

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Hearing services, PPO only

This is the archived version for Information about hearing services for PPO members only

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Home infusion therapy, PPO only

This is the archived version for home infusion therapy information for PPO members only

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Hospice care, PPO only

This is the archived version for information about hospice care for PPO members only

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Human organ transplant, PPO only

This is the archived version for information about human organ transplant for PPO members only

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Inpatient hospital care, PFFS only

This is the archived version for inpatient hospital care information for PFFS members only

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Inpatient hospital care, PPO only

This is the archived version for inpatient hospital care information for PPO members only

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LASIK, radial keratotomy, PPO only

This is the archived version for information about LASIK and radial keratotomy for PPO members only

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Private duty nursing, PPO only

This is the archived version for information about private duty nursing for PPO members only

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Remote patient monitoring, PFFS only

This is the archived version for information about remote patient monitoring for PFFS members only

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Remote patient monitoring, PPO only

This is the archived version for information about remote patient monitoring for PPO members only

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Routine physical examinations

This is the archived version for information about routine physical examinations for PPO members only

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SilverSneakers® fitness, PPO only

This is the archived version for information about the SilverSneakers® fitness program for PPO members only

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Skilled nursing facility, PFFS only

This is the archived version for skilled nursing facility information for PFFS members only

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Skilled nursing facility, PPO only

This is the archived version for skilled nursing facility information for PPO members only

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Sterilization

This is the archived version for information about sterilization for PPO members only

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Total body skin examination

This is the archived version for information about total body skin examination

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Travel and lodging, PPO only

This is the archived version for travel and lodging information for PPO members only

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Vision care, PPO only

This is the archived version for vision care information for PPO members only

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Wigs, PPO only

This is the archived version for information about wigs for PPO members only

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Worldwide coverage - emergency and urgent care, PPO only

This is the archived version for information about worldwide coverage for emergency and urgent care for PPO members only

Retired

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Bathroom safety items

This is the retired version for Information about bathroom safety items for PPO members only

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Chiropractic care

This is the retired version for Information about chiropractic care

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Clinical trial

This is the retired version for Information about clinical trials

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Consultation services by a clinical psychologist

This is the retired version for Information about consultation services by a clinical psychologist

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Contraceptive devices

This is the retired version for Information about contraceptive devices

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Dental care

This is the retired version for Information about dental care

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Dental care, PPO only

This is the retired version for information about dental care for PPO members only

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Determination of refractive state

This is the retired version for information for determination of refractive state. This is necessary for obtaining glasses and includes specification of lens type.

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Emergency department care

This is the retired version for information about emergency department care

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Foreign travel: Nonemergent, nonurgent care

This is the retired version for information for non-emergency and non-urgent medical care outside of the United States or its territories

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Gradient compression stockings

This is the retired version for information about gradient compression stockings

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Home infusion therapy

This is the retired version for information about home infusion therapy

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Hospice care

This is the retired version for information about hospice care

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Human organ transplant

This is the retired version for information about human organ transplant

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Inpatient hospital care

This is the retired version for information about inpatient hospital care

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LASIK, radial keratotomy

This is the retired version for information about LASIK and radial keratotomy

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Outpatient rehabilitation therapy caps, PPO only

This is the retired version for information about outpatient rehabilitation therapy caps for PPO members only

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Private duty nursing

This is the retired version for information about private duty nursing

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Routine hepatitis C screening

This is the retired version for information about routine hepatitis C screening

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Screening mammography

This is the retired version for information about mammography screening

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Screening pap tests and pelvic exams

This is the retired version for information about pap tests and pelvic exam screenings

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Skilled nursing facility

This is the retired version for information about skilled nursing facilities

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Temporomandibular joint appliance

This is the retired version for information about temporomandibular joint appliances

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Vision care

This is the retired version for information about vision care

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Vision care, PPO only

Vision Care

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Voluntary abortion

This is the retired version for information about voluntary abortion

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Weight loss surgery

This is the retired version for information about weight loss surgery