Health insurance costs include monthly payments, individual deductibles, drug coverage deductibles, out-of-pocket expenses, copayments, and coinsurance. For the Health Check Select plan, here’s what you can expect:

• Deductibles ranging from $200 to $5,000
• Copayment of $15 for most office visits, not subject to deductible
• Inpatient deductible of $0 applies for each occurrence, if you use the BlueChoice PPO network, $300 for all other provider networks
• No outpatient deductible applies to this plan
• No emergency room deductible applies to this plan
• Coinsurance ranging from 20 – 30 percent of allowable charges
• To view your specific costs, get a quick quote.

• Choice of any combination of family members to be covered
• Broad network of contracting doctors, hospitals and health care providers
• Health Check Select pays from 70 – 80 percent for most in-network provider services and 70 percent for most out-of-network provider services
• Plan pays 70 percent of allowable charges when you use in-network pharmacies and after annual deductible is met
• Qualified non-tobacco users receive preferred member rates
• Benefits for preventive care services covered
• No lifetime maximum
• Benefits for doctor office visits start immediately and require only a $15 copayment
• In-network benefits from doctors and other health care providers in all 50 states and in more than 200 foreign countries
• Access to Blue Care Connection^®, a series of services and programs geared towards improving your health

• Benefits are subject to pre-existing condition limitations for covered individuals age 19 and over only.
• No benefits will be provided for pre-existing conditions for a period of 12 months after coverage becomes effective. This applies to covered individuals age 19 and over only.
• This provision applies to any condition or any charges relating to a condition existing during the 12 months immediately before the effective date of coverage.

There are a couple of ways that you can customize your Health Check Select plan, including certain types of add-on coverage and insurance. The following options are available for this plan.

• Health Check Select offers an option of enrolling with maternity benefits. Coverage must be in effect for at least 365 days or more before benefits are available.
• BlueCare Dental PPO can be added for a few more dollars a month. Key features of this plan include:
  • Benefits effective immediately for checkups, cleanings and other preventive services
  • Deductible of $50 per member during benefit period; $150 maximum per family
  • Maximum benefit of $1,500 per covered individual
  • Plan pays 50 – 100 percent of allowable charges, depending on type of service, at participating dentists
  • Plan pays 30 – 70 percent of allowable charges, depending on type of service, at out-of-network dentists
  • 20 percent discount for orthodontic services at participating dentists, up to a maximum savings of $1,000
  • To learn more about BlueCare Dental PPO, including costs, view the Enrollment Guide above.

• Prescription drug coverage is included with this plan.
• Coinsurance for prescription drugs vary based on plan options you choose.
• You can optionally order your prescription drugs through the mail with our 90-Day Supply Program
• Prescription Drug Utilization/Benefit Management Programs are being added to policies with effective dates on or after 1/1/2012. See Compare Plans Chart for more information.