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Verification of Georgia Health Insurance Benefits

Verification of Benefits is available for Participants or authorized healthcare Providers on behalf of Participants. You may call Customer Service with a benefits inquiry or verification of benefits during normal business hours (7:30 a.m. to 7 p.m. eastern time). Please remember that a benefits inquiry or verification of benefits is NOT a verification of coverage of a specific medical procedure.

• Verification of benefits is Not a guarantee of payment.
• If the verified service requires pre-certification, please call 1-800-722-6614.

Pre-Admission Certification (PAC)------Required

• Required for ALL Hospital admissions except emergency or maternity delivery admissions. Please notify us within 48 hours of an emergency or maternity admission.
• Pre-Admission Certification (PAC) determinations are available by phone through BCBSHP's pre-certification staff 24 hours a day, seven days a week for urgent/non-elective care that must be performed within 24 hours after the PAC request, without which a significant threat to the patient's health or well-being will be posed.
• Non-urgent/elective pre-certifications can be requested during normal business hours (7:30 a.m. - 7 p.m. eastern time).
• The phone number for pre-certification is 1-800-722-6614.
• Emergency services do NOT require pre-certification, unless admitted as Inpatient.

PAC is a guarantee of payment as described in this section (and the Claims Administrator will pay up to the reimbursement level of this Plan when the Covered Services are performed within the time limits assigned by PAC) except for the following situations:

• The Participant is no longer covered under this Plan at the time the services are received;
• The benefits under this Plan have been exhausted (examples of this include day limits or maximum amounts);
• No benefits will be paid in cases of fraud.

Pre-certification approvals apply only to services which have been approved in the pre-certification process and only as described in the approval. Such approval does not apply to any other services. Payment or authorization of such a service does not require or apply to payment of claims at a later date regardless of whether such later claims have the same, similar or related diagnoses.

Types of Coverage
Your type of coverage is determined by your selection at the time of enrollment through the Employer Group.

Note: These benefits are valid for your Employer Group's current Contract period. You will receive a revised Summary of Benefits if there is a change in your benefits.