Living Donor Coverage The following chart summarizes when benefits are available for an organ or bone marrow/stem cell transplant from a living donor:
Both the recipient and the donor are Plan participants…
Regular contract benefits provided to the donor will be applied against the recipient’s lifetime maximum.
Only the recipient is a Plan participant…
When only the donor is a Plan participant…
The donor is entitled to regular plan benefits, but only to the extent coverage is not provided by another health care plan. Benefits provided to the donor will be charged against the recipient’s lifetime maximum. No benefits are provided.
Benefits for the following services are provided to the donor:
Search for matching bone marrow, or organ;
Transportation to and from the surgery site;
Organ or bone marrow/stem cell removal, withdrawal, and preservation; and
If benefits are approved, reimbursement for covered organ and bone marrow/stem cell transplants will be the same as other covered medical expenses.
Well-Child Care Benefits are provided for six (6) well-child care physician office visits to a participating physician from birth to age two (2), subject to the calendar year deductible. No benefits are provided for immunizations or well-newborn hospital nursery care.
The following tests are covered under well-child care benefits: routine venipuncture, glucose, tuberculosis, cytopathology, hemoglobin, hematocrit, CBC, and urinalysis.
Benefits are only provided when a participating provider renders services.
Well-Child Care (High Option for Children) For an additional premium each month, an enrollee may elect High Option for Children which provides a higher coverage level of well-child benefits for covered dependents up to age 18. This option provides coverage for well-newborn nursery care and well-child physician office visits at 100%. All benefits under the High Option for Children are subject to the individual calendar year deductible for Select Coverage and family calendar year deductible for Base Coverage.