Medical Policies

Medical policies are documents that define the plan coverage for technologies, procedures and treatments. The statements of medical necessity in the policies, about whether a technology, procedure, treatment, supply, equipment, drug or other service improves the health outcome of the population for which said technology or treatment was designed are based on scientific evidence, clinical studies and professional opinions from our providers and recognized medical organizations.

Each document displayed on this website is provided for informational purposes only and is not an authorization, explanation of benefits, or contract. Receiving benefits is subject to satisfaction of all terms and conditions of coverage. Medical technology is constantly changing, and we reserve the right to periodically review and update our policies.

Medical Policies table

ID Title Review Description Access
PP.002.010 Sleep Studies Jun 2026 This payment policy describes reimbursement guidelines applicable to sleep studies including polysomnography.... View
V5.003.002 Gene Therapies for Sickle Cell Disease Jul 2026 Sickle cell disease is a genetic hemoglobinopathy that results from a genetic variant in the hbb gene... View
V5.003.004 Gene Therapies for Duchenne Muscular Dystrophy Jun 2026 Duchenne muscular dystrophy (dmd) is an inherited disorder that results in progressive muscle weakness and... View