Although a service may be covered, there may be limitations. You are responsible for reading this booklet and knowing your benefits. Prescription Drugs Limited to legend prescription drugs. Maternity Care Covered. Mother must be enrolled.
Some surgeries require prior approval or second surgical opinion.
Outpatient Surgery Covered. Some surgeries require prior approval or second surgical opinion. Ambulance Services Requires approval over 50 miles and limited to medical emergencies. All admissions must be certified. Semi-private room rate.