When do I need a pre-authorization for any of the Plan benefits?

Pre-authorizations are required for eyelid, breast and nasal surgeries because these procedures often fall under the cosmetic exclusion. Pre-authorizations are also required for all transplant surgeries, bariatric surgeries, gender reassignment surgeries, outpatient private duty nursing and sleep studies.

Most non-elective surgeries do not require pre-authorizations. However, it is always best to contact the Plan at least two weeks prior to your proposed surgery.