G8M2PFR Blue Preferred Gold PPO 435.pdf

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Preview of G8M2PFR Blue Preferred Gold PPO 435
🔗 Source: bcbsok.com
📊 Size: 2.02 MB
👤 Author: Binu Joseph
⬇️ Downloads: 26

Summary

- Calendar year benefit period
- $3,000 deductible for Network Provider Services, $9,000 for all covered family members
- $6,000 deductible for Out-of-Network Provider Services, $18,000 for all covered family members
- Copayments: $50 office visit, $90 specialist visit, $50 urgent care, $250 diagnostic services, $400 emergency room
- Out-of-Pocket Limits: $3,000 for Network Provider Services, $9,000 for all covered family members; $6,000 for Out-of-Network Provider Services, $18,000 for all covered family members
- 100% coverage for Preventive Care Services from Network Providers
- Benefit percentage amounts vary after deductibles and copayments are satisfied.

Description

- Calendar year benefit period
- $3,000 deductible for Network Provider Services, $9,000 for all covered family members
- $6,000 deductible for Out-of-Network...

Technical Information

  • File Format: PDF
  • File Size: 2.02 MB
  • Pages: 124
  • Language: EN
  • Author: Binu Joseph
  • Total Downloads: 26
  • Last Updated: 1 week ago

Document Overview

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