OPTIONS

Description	A traditional plan allowing you to utilize any provider for services. BCBS providers accept allowable amounts as payment in full.
Single Cost	$464.00/month
Cost for Two	Not Available
Family Cost	$1,077.00/month
Choice of Physicians	Choose any provider. BCBS providers accept paid in full amounts.
Dependant Coverage	Age 19 full time student 25
Lifetime Maximum	$2,000,000 under master medical
Master Medical Rider	$100 Deductible per person (3 maximum) then 80% of first $2000 then 100% - Maximum of $2,000,000
Out of Pocket Maximum	$500 per person to a max of $1500 per family
Coinsurance	20%
Second Surgical Opinion	Covered at 80% of allowable after deductible
Hospice	Paid in Full
Annual Deductible	$100
Hospital Inpatient	Paid in full for 70 days additional days subject to lifetime maximum of $2,000,000
Hospital Outpatient	Paid in full
Lab	Paid in full
Xray	Paid in full
Inpatient Surgery	Paid in full for 70 days additional days subject to lifetime maximum of $2,000,000
Outpatient Surgery	Paid in full
Physician Office Visit	Covered at 80% of allowable amount after deductible
Physician Hospital Visit	Paid in full
Preventive Periodic Physical	Not Covered
Routine GYN Exam	Covered per guidelines for pap smears and mammograms
Child Wellness Exam	Covered per guidlines set buy American Academy of Pediatrics to age 19.
Child Immunizations	Covered per guidlines set buy American Academy of Pediatrics to age 19.
Skilled Nursing Facility	2 days in SNF = 1 day in the hospital. Subject to 70 day annual total.
Home Health Care	40 visits + 325 under master medical
Eye Care	Covered for medical conditions, no routine
Mammography Screen	Paid in full
Pap Screen	Paid in full
Allergy Testing	Covered at 80% of allowable after deductible
Allergy Treatment	Covered at 80% of allowable amount after deductible
Ambulance	Subject to deductible and coinsurance
Emergency in Area	Covered for accident or life threatening
Emergency out of Area	Covered for accident or life threatening
Prenatal Physicals	Paid in full after initial diagnosis
Post Partum Physicals	Paid in full
Delivery	Paid in full
Maternity Hospital Services	Paid in full
Nursery Care	Paid in full
Mental Health Inpatient	Not Covered
Mental Health Outpatient	Reimbursed at $20 per visit (up to 50 visits) after deductible..
Inpatient Substance Abuse	Not Covered
Outpatient Substance Abuse	Paid in full, 60 visits per year
Outpatient Physical Therapy	Covered at 80% of allowable amount after deductible
Speech Therapy	Not Covered
Chiropractic	Covered at 80% of allowable amount after deductible. Must be medically necessary.
Professional Physical Therapy	Covered at 80% of allowable amount after deductible
Occupational Therapy	Not Covered
Durable Medical Equipment	Covered at 80% after deductible, participating providers only.
Prosthetics	Covered at 80% after deductible, participating providers only.
Prescription Drug Coverage	80% for generic, 70% for tier two and 50% fpr tier three. Not subject to master medical deduction or out of pocket maximum.
Mail Order Drugs	80% for generic, 70% for tier two and 50% for tier three. Not subject to master medical deduction or out of pocket maximum.
Eye Wear	Not Covered