Below is a list of actual policy documents for Pre-Affordable Care Act – individual grandfathered or grandmothered plan – market coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.
While BCBSOK is posting every actual insurance policy as soon as it becomes available, including policies that contain customized benefit designs, your policy may not yet be available. If you are unable to locate your policy below, you may find it helpful to view one of the sample policies on the previous page, and you can also contact a customer service representative at 866-520-2507 for more information.
Policy Documents
- Health Check Basic - $1000 Deductible
- Health Check Basic - $2500 Deductible
- Health Check Basic - $3500 Deductible
- Health Check Basic - $500 Deductible
- Health Check Basic - $5000 Deductible
- Health Check Basic - $7500 Deductible
- Health Check HSA 100% OPX 2500
- Health Check HSA 100% OPX 3500
- Health Check HSA 100% OPX 3500
- Health Check HSA 80% OPX 3000 - $1500 Deductible
- Health Check HSA 80% OPX 3000 - $2000 Deductible
- Health Check HSA 80% OPX 3000 - $2500 Deductible
- Health Check HSA 80% OPX 4000
- Health Check HSA 80% OPX 5000 - $1500 Deductible
- Health Check HSA 80% OPX 5000 - $3000 Deductible
- Health Check HSA 80% OPX 5000 - $3500 Deductible
- Health Check Select - $1000 Deductible
- Health Check Select - $1500 Deductible
- Health Check Select - $200 Deductible
- Health Check Select - $2500 Deductible
- Health Check Select - $500 Deductible
- Health Check Select - $5000 Deductible
- Personal Blue
Return to Sample Policy Documents