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 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.