2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
Section 5. Benefits
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Section. There is no calendar year deductible under Basic Option.
Benefit Description
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
Note: When billed by a skilled nursing facility, nursing home, extended care facility, or residential treatment center, we pay benefits as shown here for professional care, according to the contracting status of the facility.
Standard Option - You Pay
Preferred primary care provider or other healthcare professional: $30 copayment per visit (no deductible)
Preferred specialist: $40 copayment per visit (no deductible)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Note: Benefits are limited to 75 visits per person, per calendar year for physical, occupational, or speech therapy, or a combination of all three.
Note: Visits that you pay for while meeting your calendar year deductible count toward the limit cited above.
Basic Option - You Pay
Preferred primary care provider or other healthcare professional: $35 copayment per visit
Preferred specialist: $45 copayment per visit
Note: You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care.
Note: Benefits are limited to 50 visits per person, per calendar year for physical, occupational, or speech therapy, or a combination of all three.
Participating/Non-participating: You pay all charges
Note: See Section 5(c) for our payment levels for rehabilitative therapies billed for by the outpatient department of a hospital.
Benefit Description
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
- Physical therapy, occupational therapy, and speech therapy
- Cognitive rehabilitation therapy
Note: When billed by a skilled nursing facility, nursing home, extended care facility, or residential treatment center, we pay benefits as shown here for professional care, according to the contracting status of the facility.
Standard Option - You Pay
Preferred primary care provider or other healthcare professional: $30 copayment per visit (no deductible)
Preferred specialist: $40 copayment per visit (no deductible)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Note: Benefits are limited to 75 visits per person, per calendar year for physical, occupational, or speech therapy, or a combination of all three.
Note: Visits that you pay for while meeting your calendar year deductible count toward the limit cited above.
Basic Option - You Pay
Preferred primary care provider or other healthcare professional: $35 copayment per visit
Preferred specialist: $45 copayment per visit
Note: You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care.
Note: Benefits are limited to 50 visits per person, per calendar year for physical, occupational, or speech therapy, or a combination of all three.
Participating/Non-participating: You pay all charges
Note: See Section 5(c) for our payment levels for rehabilitative therapies billed for by the outpatient department of a hospital.
Benefit Description
Not covered:
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges
Not covered:
- Recreational or educational therapy, and any related diagnostic testing except as provided by a hospital as part of a covered inpatient stay
- Maintenance or palliative rehabilitative therapy
- Exercise programs
- Equine therapy and hippotherapy (exercise on horseback)
- Massage therapy
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges