| Service |
Coverage |
Authorization Requirements |
Co-Pay: Active duty dependents & retirees with Medicare Part B |
Co-Pay: Retirees without Medicare Part B |
| Balloon kyphoplasty |
Covered |
Yes |
No |
Yes |
| Bariatric Surgery |
Limited |
Yes |
No |
Yes |
| Bath Bench or Stool |
Not covered |
N/A |
N/A |
N/A |
| Bath Rail |
Not covered |
N/A |
N/A |
N/A |
| Bed Board |
Covered |
Obtain from Apria |
No |
Yes |
| Bed Pan |
Covered |
Obtain from Apria |
No |
Yes |
| Bedwetting Correctional Devices |
Not covered |
N/A |
N/A |
N/A |
| Behavioral Health Services, Family Counseling |
Covered |
Yes - contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Inpatient |
Covered |
Yes - contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Intensive Outpatient Program |
Covered |
Yes - contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Outpatient |
Covered |
Yes - after initial 8 visits. Contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Partial Hospitalization |
Covered |
Yes - contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Residential Treatment Facility |
Limited |
Yes - contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Substance Abuse Detoxificaiton |
Covered |
Yes - contact Health Integrated |
No |
Yes |
| Behavioral Health Services, Substance Abuse Rehabilitation |
Covered |
Yes - contact Health Integrated |
No |
Yes |
| Biofeedback |
Limited |
Yes |
No |
Yes |
| Biopsy |
Covered |
No |
No |
Yes |
| BiPaP Machine |
Covered |
Obtain from Apria |
No |
Yes |
| Birthing Center |
Covered |
Yes |
N/A |
Yes |
| Bladder Stimulator |
Not covered |
N/A |
N/A |
N/A |
| Blankets, cooling/heating |
Not covered |
N/A |
N/A |
N/A |
| Blood Pressure Cuff (Sphygmomanometer) |
Not covered |
N/A |
N/A |
N/A |
| Blood tests |
Covered |
No - LabCorp is the Plan's preferred lab |
No |
No |
| Body Piercing |
Not covered |
N/A |
N/A |
N/A |
| Bone Density Scan |
Covered |
No |
No |
No |
| Bone Stimulator |
Covered |
Yes |
No |
Yes |
| Brace, body support |
Covered |
Yes - if $500 or greater |
No |
Yes |
| Braille Teaching Text |
Not covered |
N/A |
N/A |
N/A |
| Breast Implant, post mastectomy |
Covered |
Yes |
No |
Yes |
| Breast MRI |
Covered |
Yes |
No |
No |
| Breast Prosthetic, external |
Covered |
Yes - quantity limitations 1 initial and 1 replacement every 24 months |
No |
Yes |
| Breast Pump |
Covered |
Yes - if $1,000 or greater |
No |
Yes |
| Bronchoscopy |
Covered |
No |
No |
Yes |
