Bay Health Plan — Plan B Services Not Covered

Bay Health Plan Services Not Covered — Plan B

The following services are not covered through Bay Health Plan and payment will not be made for:

Inpatient hospital services
Services needed as a result of a motor vehicle accident
Services for illness that are covered under no fault law, worker’s compensation, Occupational
Disease Law or other legislation
Custodial or nursing home care
Chiropractic services
Infertility or sterilization services
Experimental procedures, treatments or drugs
Comfort or convenience items
Durable medical equipment, prosthetics and orthotics, corrective shoes or wigs
Speech, physical or occupational therapy
Hearing aid services or materials
Weight reduction services or programs
Services considered to be cosmetic
Home health services
Hospice care
Services or supplies related to sex or gender change
Vision exams, eyeglasses or contact lenses (exams by referral related to chronic illness are covered)
Dialysis services Podiatry services (exams by referral due to chronic illness are covered)
Outpatient services for TB screening or treatment
Dental services including oral surgery
Substance abuse screening and treatment
Mental health clinic services
Organ transplants
Maternity or obstetrical services^**
Medical services to anyone incarcerated
Diagnosis or treatment of an injury or illness which occurs from an act of war, commission of a felony or illegal business
Contraceptive methods or fertility drugs
Any condition for which an enrollee is eligible to receive health care services or benefits through a public or private benefit, program or insurance
Lodging expenses
Emergency transportation by air Office visits, exams, treatments or tests related to documentation of health for employment, insurance, marriage license, school, sports physicals, citizenship or any legal proceeding or court-mandated activity
Services received before the effective date of enrollment or after the termination of enrollment
Over-the-counter medicines or supplies such as first aid materials or vitamins
Services not approved by the Bay Health Plan doctor on your enrollment card or by a specialist you are referred to
Services that are not medically necessary
Emergency services out of Michigan

^**If you become pregnant while a member of Bay Health Plan, you should contact the local Department of Human Services and ask about Medicaid eligibility as soon as possible. Remember to avoid drugs and alcohol if you suspect you may be pregnant.