Information for

The following medical services require prior authorization by the Fund:

• Outpatient Magnetic Resonance Imaging (MRIs)
• Computed Axial Tomography (CT or CAT scans)
• Electromyograms (EMGs, nerve tests and studies)
• Sleep Apnea (studies, treatment, devices, test, surgery, or any services related to sleep disorders)
• Vein surgery
• Nasal surgery/Rhinoplasty
• Gastric Bypass surgery
• Genetic testing
• Breast Reduction
• Blepharoplasty (eyelid surgery)

If the particular course of treatment or medical service is not certified/authorized, it means that the Plan will not consider that course of treatment as appropriate for reimbursement under the Plan.  Failure to obtain prior authorization for the required medical services and procedures listed will result in a denial of benefits when your claim is received for processing.