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Plan J BCBSVT's Plan J is a traditional, fee-for-service health benefits plan offering first-dollar coverage for hospital and physician expenses. You get the most from your benefits when you use participating providers. Participating providers bill us directly for their services, eliminating up-front payments and relieving you of complicated paperwork. They also accept our allowed price as payment in full, billing you only for coinsurance and deductible when appropriate. For a complete description of your health plan's benefits, please read your contract carefully. Hospital (Facility) Expenses We cover hospital expenses without a deductible. We cover room and board charges for a necessary inpatient stay. Check your Outline of Coverage for your limit on the number of covered days per admission. Please be sure to follow Precertification Program guidelines if they apply to your coverage. Calling us protects you from having to pay for unnecessary and noncovered hospital stays. We also cover outpatient hospital services provided to you as an outpatient. This includes charges related to outpatient surgery, diagnostic procedures, or emergency room charges for an emergency medical condition Physicians' Expenses We cover physicians' expenses without a deductible. Benefits for physicians' services include surgery charges, doctors' visits while you're inpatient in a hospital, and maternity charges like prenatal care and delivery. Your Plan J offers our popular Better Beginnings program for expectant parents. Doctor's Office Visits Benefits for office visits include chiropractic visits and mental health and substance abuse treatment visits. You pay your office visit co-payment for each visit. Your co-payment is listed on your Outline of Coverage. Mental health and substance abuse treatment visits Most plans require that you use a provider in our behavioral health care network and also that you call for prior approval to initiate care. If your coverage includes Open Network Mental Health, these terms do not apply to your coverage. Your Outline of Coverage indicates if you have Open Network Mental Health benefits. Chiropractic visits We cover chiropractic visits to treat neuromusculoskeletal conditions if you use a Participating provider. Any visits after 12 in a calendar year require Prior Approval from us. Your chiropractor must send us a treatment plan to get approval for additional visits in that year. We do not cover chiropractic services rendered by Nonparticipating providers. Other Benefits We apply deductible and coinsurance to certain types of service. We list those services on your Outline of Coverage. |
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