Health Check Select®
|Benefit Highlight||Health Check Select|
|Participating Providers||Blue Choice PPO Network
Blue Traditional Network
|Individual Out-of-Pocket Expense Limits||Blue Choice PPO Network: $1,000 per member
Blue Traditional and Out-of-Network: $3,000 per member
The percentage you pay for services after deductible and applicable copayments are met.
|You pay 20-30% after deductible|
|Optional Maternity Coverage||Available|
|Optional Dental Coverage||Coverage available from BlueCare Dental PPO|
|Prescription Drugs||You pay 30% after deductible satisfied for in-network pharmacies|
|Prescription Drug Utilization/ Benefit Management Programs (for policies with effective dates on or after 1/1/2012)||Dispensing Limits: Benefits include coverage limits on certain medications. These limits are based on approved guidelines.
Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSOK and/or certain criteria must be met.
Specialty Pharmacy Program: Specialty medications must be received through the preferred Specialty Pharmacy Provider.
Reminder about coverage for self-administered specialty medications
Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay the share plus the difference in cost.