Overview of Benefits for Alabama Personal Choice

Some groups have benefits that vary from the model provided below. Please verify patient benefits if you have questions.

Female members have two types of routine preventive care benefits:

• An annual routine office visit for an obstetrics and gynecology (OB/GYN) examination. This may be provided by an OB/GYN participating in the Blue Cross Preferred Medical Doctor (PMD) program or by the Primary Care Physician (PCP).

• An office visit for routine physical examination, according to the ages shown on the benefit matrix. A female member may see her PMD OB/GYN up to two times per year and receive in-network level of benefits without a referral from her PCP. Please verify benefits and eligibility for contract specific limits.  One of the visits may be for the routine annual OB/GYN visit and another requires a medical diagnosis. If she has received her annual OB/GYN visit from her PCP, each of the self-referred OB/GYN visits must have a diagnosis because she has already used her annual routine OB/GYN visit with her PCP. Self-referrals to the OB/GYN include only services performed in the office that day plus mammograms and pap smears. Pregnancy and maternity services always require a referral and are never considered self-referral OB/GYN visits.

A woman may receive the tests listed in the routine preventive care section of the PCN benefit matrix from either the PCP or her OB/GYN. However, payment for the number and timing of the tests will not exceed the description in the PCN benefit matrix shown under routine preventive care.

Last Updated March 2010