How do we decide which health care services to cover? We take a number of factors into account, including:

• The terms of your specific benefit plan
• Applicable state and federal laws

We also determine if services are medically necessary. To do so, we rely on our medical policies.

What are medical policies?

Our medical policies include evidence-based treatment guidelines. They address common medical situations.

You can review our medical policies online any time. Please keep in mind that:

• The policies aren’t medical advice. They don’t guarantee results or outcomes.
• These policies may change to stay up to date with current research. A posted policy may not reflect a recent change.
• We share these policies as information only. The health plan decides how they apply.
• Just because a service is included in a medical policy doesn’t mean your specific health plan covers it.

These policies address situations that occur frequently. Some situations may warrant further individual review.