Blue Pathway SM
Open Enrollment is now closed for this product. The next open enrollment period is scheduled for June 1, 2013 - July 31, 2013.
Our children's health insurance plan, Blue Pathway, provides coverage for individuals ages 1 through 18 and includes:
- Benefits for preventive care services
- Diagnostic testing
- Hospital services
- Emergency care
- Prescription drug coverage
- Physical and occupational therapy services
Blue Pathway provides guaranteed acceptance for applicants who are at least one year old and under 19 years of age.
View the features, options and costs of the Blue Pathway plan to find out if it's right for you.
Open Enrollment is now closed for this product.
Open Enrollment Periods
- An applicant may apply for Blue Pathway coverage during the Annual Enrollment Period, which is from June 1, 2013 - July 31, 2013.
- Use this time to enroll in Blue Pathway for the first time or to switch plans
A child who is between 1 and 19 years of age, who involuntarily loses his or her major medical coverage and does not have other major medical coverage for purchase, can apply year-round for enrollment in Blue Pathway. A child who is eligible for special enrollment in Blue Pathway must apply within 31 days from the date he or she involuntarily lost coverage, or was notified that he or she lost that coverage – whichever is later.
If you have a qualifying event and are eligible for this product, you can get a quote and apply.
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments and coinsurance. For Blue Pathway plans, here's what you can expect:
- Individual in-network deductible of $2,500
- Family in-network deductible of $7,500
- Coinsurance levels of:
- Blue Preferred PPO – 80% in-network/50% out-of-network
- BlueChoice PPO – 70% in-network/50% out-of-network
- Blue Traditional – 60% in-network/50% out-of-network
- Benefits for preventive care services covered at 100% in-network/70% out-of-network
For more information on costs, including out-of-pocket costs, see the Outline of Coverage document under What's Included with Blue Pathway below.
At Blue Cross and Blue Shield of Oklahoma (BCBSOK), we understand your concerns about coverage continuity. BCBSOK will never terminate or refuse to renew your policy because of the condition of your health. However, to protect you and the rights of all policy holders, there are situations when a plan may be terminated or a renewal refused:
- Failure to pay premiums
- The plan is discontinued (90 days notice given with an option to convert to any plan we offer)
- Discovery of fraud or an intentional misrepresentation of facts (30 days prior written notice given)
- If you no longer reside, live or work in an area where we are authorized to do business
For more information on renewability, see the Blue Pathway Outline of Coverage
It's important to know the features of the health insurance plan you are considering. Our Outline of Coverage documents give you brief descriptions of the basic details of our Blue Pathway product, as well as details on renewability, exclusions and limitations.
- Generic Drugs (Tier 1*) - $15 copayment in network
- Preferred Brand Drugs (Tier 2*) – 80% coinsurance level - in network
- 50% generic and preferred brand drugs – out-of-network**
- Your benefit plan includes a mail service program that offers you the convenience of having covered maintenance medications delivered directly to you.
- Your out-of-pocket cost for prescription drugs usually is less when you choose generic or preferred.
*Tier 1 and 2 benefits paid after plan medical deductible has been satisfied.
**Benefits apply to the deductible. A separate out-of-pocket limit is applicable for drugs $2,000 at participating pharmacies/$4,000 at non-participating pharmacies