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Lifetime Dollar Maximum Changes

February 10, 2011

Blue Cross and Blue Shield of Texas (BCBSTX) will no longer impose lifetime dollar maximums on essential health benefits.* This change is effective for all health plans, including grandfathered health plans, for plan/policy years beginning on or after Sept. 23, 2010. As a result of this change, you will no longer see information related to lifetime dollar maximums on your Provider Claim Summary (PCS), Electronic Payment Summary (EPS), and other related documentation and/or online applications. BCBSTX will continue to use lifetime dollar maximums, as applicable, on non-essential health benefits.

For a partial listing of essential health benefits, as determined by BCBSTX for purposes of addressing annual and lifetime dollar maximums, visit the Claims and Eligibility section of our website at bcbstx.com/provider. Look for the Essential/Non-essential Benefits Listing, under “Related Resources.”

>*Some self-insured plans may retain limits on certain benefits.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.