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Note Prior approval may be required If the physician does not report the physician to the Medicare carrier that sent you the MSN form For over 65 years MHBP has served all https://www.bitsdujour.co...les/SGVdlB and postal service employees and annuitants offering comprehensive benefits at affordable rates Reliable evidence shall mean only published reports and articles in the authoritative medical and scientific literature the written protocol or protocols used by the treating facility or the protocol s of another facility studying substantially the same drug device biological product or medical treatment or procedure or the written informed consent used by the treating facility or by another facility studying substantially the same drug device biological product or medical treatment or procedure The reward is available once per calendar year to all me mbers age 68 and older and can be used by any covered family member Note Prior approval is required for chemotherapy radiation therapy and hyperbaric oxygen therapy This does not include reduction or termination due to benefit changes or if your enrollment ends Both benefit packages are described in Section 5 All benefits are subject to the definitions limitations and exclusions set forth in the official Plan Brochure We apply Aetna claim editing criteria and or the National Correct Coding Initiative NCCI edits published by the Centers for Medicare and Medicaid Services CMS in reviewing billed services and making Plan benefit payments for them You may be prosecuted for fraud for knowingly using health insurance benefits for which you have not paid premiums We will not make our decisions regarding hiring compensation termination promotion or other similar matters with respect to any individual such as a claims adjudicator or medical expert based upon the likelihood that the individual will support the denial of benefits Note See Section 5 h Compassionate Care program for information about additional programs to support end of life care Department of Health and Human Services that provides up to date information on the Marketplace Note For all hearing services related to medical diagnosis see Section 5 a Diagnostic and treatment services Note If your Network provider uses a Non Network lab or radiologist we will pay Non Network benefits for any lab and X ray charges When our initial decision is based in whole or in part on a medical judgment i e medical necessity experimental investigational we will consult with a healthcare professional who has appropriate training and experience in the field of medicine involved in the medical judgment and who was not involved in making the initial decision Make sure you understand what will happen if you need surgery Your facility will file on the UB 59 form Because you are still responsible for ensuring that this requirement is met you should always confirm that your physician has contacted us and that we have approved the procedure You may be responsible for amounts over the allowance If you haven t logged in before you ll need to register for a member account The period from entry admission into a hospital or other covered facility until discharge We must receive all charges for each claim by December 86 of the year after the year you received the service unless timely filing was prevented by administrative operations of Government or legal incapacity provided the claim was submitted as soon as reasonably possible We use the Department of Veterans Affairs VA Medicare equivalent Remittance Advice MRA when the statement is submitted to determine our payment for covered services provided to you if Medicare is Primary when Medicare does not pay the VA facility Fee for service plans arrive at their allowances in different ways so their allowances vary If you do not agree with our initial decision you may ask us to review it by following the disputed claims process detailed in Section 8 of this brochure Send us all the documents for your claim as soon as possible To find a location near you visit our Web site at www MHBP com Note For child screening testing diagnosis and treatment see Section 5 a Preventive care children If prior approval is denied we will not pay any benefits Note See Section 5 h Wellness and other Special Features for additional information on TeleHealth services You must tell us if you or a covered family member has coverage under any other health plan or has automobile insurance that pays healthcare expenses without regard to fault Note Only transplants performed at hospitals designated as IOE will be considered for Network benefits Remember If you are an annuitant and you cancel your FEHB coverage you may not re enroll in the FEHB Program This law mandates that you be enrolled for Self Plus One or Self and Family coverage in the FEHB Program if you are an employee subject to a court or administrative order requiring you to provide health benefits for your child ren You may authorize direct payment to any other provider of care by signing the assignment of benefits section on the claim form or by using the assignment form furnished by the provider of care Aetna Medicare Advantage for MHBP Standard Option is subject to Medicare rules We have a program that allows members to have their 95 day supply medications delivered by mail Services we provide benefits for as described in this brochure The hospice team must include a doctor and a nurse R N and also may include a social worker clergyman counselor volunteer clinical psychologist physical therapist or occupational therapist The eyeglasses or contact lenses must be purchased within one year of the injury or surgery and the patient must be covered by the Plan at the time of purchase You may be billed for services received directly from your provider Contact your employing office for further information Note See Section 5 b for transplant related professional services For new enrollees the calendar year begins on the effective date of their enrollment and ends on December 86 of the same year Note Prior approval for BRCA genetic testing is required Note You are the only person who has a right to file a disputed claim with OPM Note When a newborn requires definitive treatment during or after the mother s hospital stay the newborn is considered a patient in their own right A medical emergency is the sudden and unexpected onset of a condition requiring immediate medical care

Member since: Monday, November 10, 2025

Website: https://www.bitsdujour.com/profiles/SGVdlB