2023-standard-and-basic-options.fepbrochures-bcbsa.com

Your catastrophic protection out-of-pocket maximum for …

WebNon-preferred Provider maximum – For a Self Only enrollment, your out-of-pocket maximum for your deductible, and for eligible coinsurance and copayment amounts, is $8,000 …

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Standard and Basic Options

WebSection 6. General Exclusions - Services, Drugs, and Supplies We Do Not Cover. Section 7. Filing a Claim for Covered Services. Section 8. The Disputed Claims Process. Section 9. …

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Durable Medical Equipment (DME)

WebDurable medical equipment (DME) is equipment and supplies that are: Prescribed by your attending physician (i.e., the physician who is treating your illness or injury); Medically …

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Blue Health Assessment

WebBlue Health Assessment The Blue Health Assessment (BHA) questionnaire is an easy and engaging online health evaluation program which can be completed in 10-15 minutes. …

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Summary of Benefits for the Blue Cross and Blue Shield Service …

Web81 - 85. Emergency benefits: Accidental injury. PPO: $35 copayment for urgent care; $250 copayment for emergency room care. Non-PPO: $250 copayment for emergency room …

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Coverage information

WebCoverage information. No pre-existing condition limitation. Minimum essential coverage (MEC) Minimum value standard. Where you can get information about enrolling in the …

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TRICARE and CHAMPVA

WebTRICARE is the healthcare program for eligible dependents of military persons, and retirees of the military. TRICARE includes the CHAMPUS program. CHAMPVA provides health …

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Section 6. General Exclusions

WebThe exclusions in this Section apply to all benefits. There may be other exclusions and limitations listed in Section 5 of this brochure. Although we may list a specific service as …

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Summary of Benefits for the Blue Cross and Blue Shield Service …

Web95 - 96. Emergency benefits: Medical emergency. PPO urgent care: $30 copayment; PPO and Non-PPO emergency room care: 15%* of our allowance; Regular benefits for …

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Reimbursement Account for Basic Option Members Enrolled in …

WebReimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B. Basic Option members enrolled in Medicare Part A and Part B are eligible to be …

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Differences between our allowance and the bill

WebYou are responsible for your coinsurance, so you pay 35% of the $100 Plan allowance or $35. Plus, because there is no agreement between the Non-participating physician and …

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Section 2. Changes for 2023

WebStandard and Basic Options. Section 2. Changes for 2023. Section 2. Changes for 2023. Changes to our Standard Option only.

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WebWhen you have other health coverage - 142. • TRICARE and CHAMPVA - 142. • Workers’ Compensation - 143. • Medicaid - 143. When other Government agencies are …

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Home Health Services

WebThere is no calendar year deductible under Basic Option. Benefit Description. Home Health Services. Home nursing care (skilled) for two hours per day when: Standard Option - You …

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2023 Rate Information for the Blue Cross and Blue Shield Service

WebMonthly government share: $1,214.46. Monthly your share: $472.12. Basic Option, Self and Family, Enrollment Code 112: Premium Rate. Biweekly government share: $611.42. …

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