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Introduction     



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Getting Care

Access Standards for Care
Routine, Emergency and Urgent Care
Specialty Care
Prior Authorizations for Care (New list effective April 1, 2009)
Getting a Second Opinion and Point of Service Options  

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Covered Services, Limitations and Exclusions      

Outpatient Services
Inpatient Services
Clinical Preventive Services
Behavioral Health Care Services
Behavioral Health Care Services - Coverage Details
Substance Use Disorder Services
Telemedicine Services
Pharmacy Types
Pharmacy Services
Dental Options
Maternity Services
Hospice Care
ECHO
Services or Procedures with Significant Limitations
Exclusions 

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Claims

Health
Pharmacy    
Coordinating with Other Health Insurance
Appealing a Claim or Authorization Denial
Third Party Liability, Explanation of Benefits & Debt Collection Assistance Officers 

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Life Events

Getting Married
Getting Divorced
Having a Baby or Adopting a Child  
Going to College
Traveling
Filling Prescriptions on the Road 
Moving
Separating from the Service
After Active Duty
Survivor and Dependent Parent Coverage
Loss of Eligibility 

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Information and Assistance

Appeals
Grievances
Fraud and Abuse
Patient Bill of Rights and Responsibilities 
 
Last Update: December 22, 2009