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Blue Cross and Blue Shield Service Benefit Plan
Note: When billed by a skilled nursing facility, nursing home, extended care facility, or residential treatment center, we pay benefits as shown here for
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BLUE OPTIONS BENEFIT HIGHLIGHTS (PPO)
Skilled Nursing Facility (60 days per benefit period). 20% after deductible. 30% after deductible. Home Health Care, Durable Medical Equipment and Hospice. 20
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Pre-Authorization Rules Starting on 1/1/20
Preauth for CNY PPO members for all other services is managed for CNY by Empire BCBS. **This list contains all PA codes, including codes that have site of
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