OTHER BASIC BENEFIT COVERAGES

Dialysis services to treat acute renal (kidney) failure and end stage renal disease (ESRD) are a benefit. Treatment may take place in the inpatient or outpatient department of a hospital, in a licensed facility, or in the home. Covered modalities include hemodialysis and peritoneal dialysis, including continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and intermittent peritoneal dialysis (IPD).

Expenses also are covered for training, supplies, and either living-related, living-unrelated, or cadaver kidney transplants. (See page 31-34, "Human Organ Transplant Program," for further information.)

ESRD treatment services are coordinated with Medicare. It is important that individuals with ESRD apply immediately for Medicare coverage regardless of age in order to maximize available health care benefits.

This benefit covers the cost of equipment, installation, training, and necessary hemodialysis supplies. Services must be arranged by a physician and billed by a BCBSM participating hospital that has an approved hemodialysis program.

This program provides benefits for necessary medications and supplies (including syringes, needles and the antihemophilia factor) used to treat hemophilia in a home setting. All medications, services and supplies needed for the patient to self-infuse at home, including syringes, needles, and the antihemophilia factor, must be supplied by a BCBSM participating hospital. Benefits also may include training for the patient or a family member on how to administer the antihemophilia factor when the training is provided through a BCBSM participating hospital.

The State Health Plan Advantage covers those hospital and professional medical expenses associated with non-experimental transplants of human organs and body tissues. Transplants of artificial organs are not covered.

There is no lifetime maximum benefit limitation applicable to this benefit.

Your benefit also covers those hospital, surgical, laboratory, and X-ray expenses incurred by a person who is donating an organ or tissue to you or your enrolled family member if that donor is not covered for the donation expenses under any other medical plan. Eligible donor expenses are payable to the same extent as though that person’s expenses were incurred by you.

Benefits are not payable for an organ or tissue transplant if you or your enrolled family member is the donor for a recipient who is not also covered under the State Health Plan Advantage.

The following types of human organ transplants are covered when performed at a facility approved by the BCBSM Human Organ Transplant Program:

It is also common for two transplants to be done together. This is referred to as "tandem" transplantation. Some of the more common types include: pancreas-liver, pancreas-kidney, and small intestine-liver. These types of transplants also are covered under the State Health Plan Advantage.

Covered services include:

Your coverage also includes transplants of the patient’s own bone marrow and/or the patient’s own peripheral blood stem cells when used to rescue that patient after receiving high doses of chemotherapy.

Payable benefits for the acquisition of donor marrow or peripheral stem cells include:

To contact the Human Organ Transplant Program, please call 1-800-242-3504 or send your written inquiries and requests for prior approval to:

Human Organ Transplant Program Exclusions

In addition to the plan’s general exclusions and exclusions listed elsewhere in this section, the following services and charges are not covered: