Annual medical out-of-pocket maximum after deductible
$1,000 - $2,000
Annual prescription out-of-pocket maximum
$5,000
Lifetime benefit maximum
$2 million for each covered family member
Office visit
$20 co-payment
Well-baby care through age 2
$20 co-payment
Childhood immunizations through age 18
$10 co-payment
Deductibles
$1,000, $2,500, $5,000
After medical deductible is met
We pay 80% of eligible services provided by an Advantage provider
and 60% of eligible services provided by a non-Advantage provider
Prescriptions
You pay a $15 co-payment for generic medications and 50% for
all other medications. See the Pharmacy Directory for a pharmacy
in your area.
Travel benefit
The BlueCard Program allows you to see any participating Blue
Cross or Blue Shield doctor when you travel.
*The Plan Overview is a brief summary
of benefits for illustrative purposes only. Download the full
brochure for more complete information on benefits.
Plan Highlights
Covers children between the ages of 0 and 17 years who are not
eligible for Medicare
Attractive monthly rate starting at $40 per month, per child
(amount varies by the deductible)
Easy $10 co-payments for office visits, childhood immunizations
and well-baby care
How to Use Your Medical Benefit
Each time your child visits their primary care physician (PCP),
you only have to pay a $10 co-payment. These services do not apply
toward the deductible.
Coverage for other services (such as hospitalization, laboratory
and x-ray, and rehabilitative care) varies depending on the kind
of service received and the type of provider giving the care. We
pay 80% for services when you see an Advantage provider or 60% for
a non-Advantage provider, after you pay your calendar year deductible.
To summarize, the same services are covered, regardless of which
provider you choose, but when you use Advantage providers, we will
pay a larger percentage of your eligible expenses and Advantage
providers will not bill you separately for balances over our agreed
upon amount. This feature is called hold harmless.
NOTE: ALL information contained in this site is for illustration purposes only, and by NO means should be considered individual tax or legal advice under any circumstances whatsoever!
Lynn R. Siewert AIMC Pension Consultant | Branch Manager CA Insurance License #00B00579 2005 E. Evergreen Blvd Vancouver, WA 98661
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