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| Available in this county |
Clark County, Washington |
| Find a doctor in this directory |
Preferred Provider (PPO) Directory |
Annual medical out-of-pocket maximum, after deductible
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$2,000 - $3,000 |
| Lifetime benefit maximum |
$2 million for each covered family member |
Office visit
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$20 co-payment |
| Annual women's exams |
$20 co-payment |
| Childhood immunizations |
$20 co-payment |
| Well-baby care through age 2 |
$20 co-payment |
| Deductibles |
$1,000, $2,500, $5,000 |
| After medical deductible is met |
We pay 80% of eligible preferred provider services and 70%
of eligible non-preferred provider services. |
| Prescriptions |
You pay a $15 co-payment for generic medications and 30% for
medications on Choices 2000. If your brand name medication is
not on Choices 2000, you pay 50%. See the Pharmacy Directory
for a pharmacy in your area. |
| Travel benefit |
The BlueCard Program allows you to see any participating or
PPO 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
- Office visits for a $20 co-payment
- Childhood immunizations, well-baby care and annual women's exams
available that does not apply toward your deductible
- Eye exam and one pair of glasses every 24 months
How to Use Your Medical Benefit
You pay a $20 co-payment that does not apply toward the deductible
or coinsurance for basic services, such as office visits, annual
women's examinations (including related Pap smear and routine mammography),
allergy shots, childhood immunizations through age 18, and well-baby
care through age two.
We pay other medical services provided by a preferred provider
at 80% after your calendar year deductible is met. Of course, you're
not limited to preferred providers. Once your medical deductible
is met, you may seek care from a non-preferred provider and we pay
70% of these costs.
The same services are covered regardless of which provider you
choose, but when you use preferred providers we pay a larger percentage
of your covered expenses. Another reason for seeing a preferred
or participating provider is that they will not bill you separately
for balances over our agreed upon amount. This feature is called
hold harmless.
How to Use Your Prescription Medication Benefit
When you choose a generic medication, you pay a simple $15 Co-pay
per prescription filled. For medications on Choices 2000, our Preferred
Medication List (PML), you pay 30% of the medication cost. Should
you decide to purchase a non-preferred brand medication, you pay
50%.
Here are a few tips that will help you maximize the benefit from
your prescription medication plan:
- Review Choices 2000 to identify generic medications and preferred
brands that are covered by your plan to help you save money.
- Purchase your prescriptions from a participating pharmacy and
present your ID card at the time of purchase.
- If you forget your card, you can submit a paper claim form to
us for reimbursement. You will be reimbursed based on the amount
of the claim, minus a $10 processing fee.
- Prescriptions purchased from a non-participating pharmacy will
be covered at 50%. You can submit a paper claim to us for reimbursement.
After you reach your maximum prescription out-of-pocket amount
of $5,000, we will pay 100% of eligible prescription costs for the
remainder of the calendar year. (Please note, this amount is separate
from the annual medical out-of-pocket maximum.)
Full Brochure
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