BlueChoice PPO Individual Health Plan Exclusions

Authorized Agent*

As with all health plans, there are some exclusions.
Your contract does not provide benefits for:

Pre-existing conditions (any illness, injury or other condition for which medical advice, diagnosis, care or treatment was recommended or received from a Physician or other health care provider prior to the effective date of coverage or which existed prior to the effective date of coverage) until your coverage has been in force for 12 consecutive months (or longer if a waiver is issued)

injury or disease recognized as compensable under Workers' Compensation;

outpatient services for mental health care and substance abuse treatment;

maternity benefits (available on family contracts only) for the first 12 months of coverage, regardless of when the pregnancy occurs;

services and supplies not medically necessary or not consistent with the diagnosis;

treatment for which payment is made by any local, state or federal government (except Medicaid);

services paid under Medicare or the Veterans Administration;

any injury or disease related to war, declared or undeclared, or the military service;

convalescent or custodial care;

hair transplants;

eyeglasses/contact lenses/radial keratotomy and the examinations associated with them;

hearing aids;

experimental services;

weight reduction or treatment for obesity;

dental care and treatment and oral surgery (except for extraction of impacted teeth);

physical therapy/occupational therapy, chiropractic care or speech therapy if such services are necessitated by developmental delay.

A full disclosure of all benefits, exclusions and limitations is included in the contract for this coverage.

Click here for the Blue Value Select plans

Click here for the Blue Value plans

Click here for the Right Plan PPO plan

Click here for the High Deductible (HSA eligible) plans

Click here to have a kit mailed or e-mailed to you

Click here to download Blue Cross application
(Adobe Acrobat reader is necessary to download this file.)
Click here to download the free Adobe Acrobat reader

5 Dunwoody Pk. South
Suite 110
Atlanta, GA 30338
Call Terri or Holly at
(770) 396-9517
Outside of the Atlanta area,
call toll-free:
1-877-711-8376.
Email: tpinsurancenow@mindspring.com

*Blue Cross and Blue Shield of Georgia is an independent licensee of the Blue Cross Blue Shield Association

Authorized Agent*
As with all health plans, there are some exclusions. Your contract does not provide benefits for:
	Pre-existing conditions (any illness, injury or other condition for which medical advice, diagnosis, care or treatment was recommended or received from a Physician or other health care provider prior to the effective date of coverage or which existed prior to the effective date of coverage) until your coverage has been in force for 12 consecutive months (or longer if a waiver is issued)
	injury or disease recognized as compensable under Workers' Compensation;
	outpatient services for mental health care and substance abuse treatment;
	maternity benefits (available on family contracts only) for the first 12 months of coverage, regardless of when the pregnancy occurs;
	services and supplies not medically necessary or not consistent with the diagnosis;
	treatment for which payment is made by any local, state or federal government (except Medicaid);
	services paid under Medicare or the Veterans Administration;
	any injury or disease related to war, declared or undeclared, or the military service;
	convalescent or custodial care;
	hair transplants;
	eyeglasses/contact lenses/radial keratotomy and the examinations associated with them;
	hearing aids;
	experimental services;
	weight reduction or treatment for obesity;
	dental care and treatment and oral surgery (except for extraction of impacted teeth);
	physical therapy/occupational therapy, chiropractic care or speech therapy if such services are necessitated by developmental delay.
	A full disclosure of all benefits, exclusions and limitations is included in the contract for this coverage.

5 Dunwoody Pk. South Suite 110 Atlanta, GA 30338	Call Terri or Holly at (770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: tpinsurancenow@mindspring.com
*Blue Cross and Blue Shield of Georgia is an independent licensee of the Blue Cross Blue Shield Association