Not Covered (Inpatient or Outpatient)

2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5(e). Mental Health and Substance Use Disorder Benefits
Not Covered (Inpatient or Outpatient)

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

Not Covered (Inpatient or Outpatient)

Marital, family, educational, or other counseling or training services
Services performed by a noncovered provider
Testing for and treatment of learning disabilities and intellectual disability
Inpatient services performed or billed by residential treatment centers, except as described on pages 87-88 and 100-101
Services performed or billed by schools, halfway houses, group homes or members of their staffs

Note: We cover professional services as described on pages 99 -100 when they are provided and billed by a covered professional provider acting within the scope of their license.
Psychoanalysis or psychotherapy credited toward earning a degree or furtherance of education or training regardless of diagnosis or symptoms that may be present
Services performed or billed by residential therapeutic camps (e.g., wilderness camps, Outward Bound, etc.)
Hippotherapy/equine therapy (exercise on horseback)
Light boxes
Custodial or long term care (see Definitions)
Costs associated with enabling or maintaining providers’ telehealth (telemedicine) technologies, non- interactive telecommunication such as email communications, or asynchronous store-and-forward telehealth services

Standard Option - You Pay
All charges

Basic Option - You Pay
All charges