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Premera Blue Cross - Online application
Index | Exclusions
& Limitations | Provider
List | Download Application
Benefit Schedule:
Preferred
35
Rate Schedule:
Preferred
35
What is not covered.
Benefits are not provided for treatment, surgery, services,
drugs or supplies for any of the following:
- Learning disorders
- Neurodevelopmental disabilities
- Chemical dependency
- Infertility
- Sexual dysfunction
- Sterilization or its reversal
- Obesity/morbid obesity, including surgery, food and exercise programs
- Cosmetic or reconstructive surgery (except as specifically
provided)
- Dental services (except as specifically provided)
- Hearing examinations or hardware
- Temporomandibular joint disorder (TMJ)
- Orthognathic surgery
- Services payable by other types of insurance coverage
- Experimental or investigative services
- Over-the-counter or non-prescription drugs
- Services in excess of specified benefit maximums
- Services received when you are not covered by this
program
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