Language Access Services Sample Clauses

Language Access Services. Spanish (Español): Para obtener asistencia en Español, llame al 0-000-000-0000. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 0-000-000-0000. Chinese (中文): 如果需要中文的帮助，请拨打这个号码 0-000-000-0000. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 0-000-000-0000. ––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next page.–––––––––––––––––––––– Don’t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See the next page for important information about these examples. These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. ■ Amount owed to providers: $7,540 ■ Plan pays $6,550 ■ Patient pays $1,845 Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 ■ Amount owed to providers: $5,400 ■ Plan pays $3,945 ■ Patient pays $1,455 Prescriptions $2,900 Medical Equipment and Supplies $1,300 Office Visits and Procedures $700 Education $300 Laboratory tests $100 Vaccines, other preventive $100 Deductibles $500 Copays $775 Coinsurance $180 Limits or exclusions $0 Note: These numbers assume the patient is filling scripts at a participating pharmacy. Deductibles $1,000 Copays $45 Coinsurance $800 Limits or exclusions $0 • Costs don’t include premiums. • Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan. • The patient’s condition was not an excluded or preexisting condition. • All services and treatments started and ended in the same coverage period. • There are no other medical expenses for any member covered under this plan. • Out-of-pocket expenses are based only on treating the condition in the example. • The patient received all care from in- network providers. If the patient had received care from out-of-network providers, costs would have been higher. For each treatment situation, the Coverage Example helps you see how deductibles, copayments, and coinsurance can add up. It also helps you see what expenses might be...

Language Access Services. Spanish (Español): Para obtener asistencia en Español, llame al 0-000-000-0000. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 0-000-000-0000. Chinese (中文): 如果需要中文的帮助，请拨打这个号码 0-000-000-0000. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 0-000-000-0000. ––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next page.–––––––––––––––––––––– Blue Cross Blue Shield Michigan: Division 0049 Coverage Period: 01/01/2016 – 12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Covered Individuals | Plan Type: PPO Don’t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See the next page for important information about these examples. These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. ■ Amount owed to providers: $7,540 ■ Plan pays $4,935 ■ Patient pays $2,605 Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 ■ Amount owed to providers: $5,400 ■ Plan pays $3,545 ■ Patient pays $1,855 Prescriptions $2,900 Medical Equipment and Supplies $1,300 Office Visits and Procedures $700 Education $300 Laboratory tests $100 Vaccines, other preventive $100 Deductibles $1,000 Copays $775 Coinsurance $80 Limits or exclusions $0 Note: These numbers assume the patient is filling scripts at a participating pharmacy. Deductibles $1,900 Copays $45 Coinsurance $660 Limits or exclusions $0 Blue Cross Blue Shield Michigan: Division 0049 Coverage Period: 01/01/2016 – 12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Covered Individuals | Plan Type: PPO • Costs don’t include premiums. • Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan. • The patient’s condition was not an excluded or preexisting condition. • All services and treatments started and ended in the same coverage period. • There are no other medical expenses for any member cove...

Language Access Services. For assistance in a language below please call the number on the back of your BCBSM ID card. SPANISH (Español): Para ayuda en español, llame al número de servicio al cliente que se encuentra en este aviso ó en el reverso de su tarjeta de identificación. TAGALOG (Tagalog): Para sa tulong sa wikang Tagalog, mangyaring tumawag sa numero ng serbisyo sa mamimili na nakalagay sa likod ng iyong pagkakakilanlan kard o sa paunawang ito. CHINESE (中文): 要获取中文帮助，请致电您的身份识别卡背面或本通知提供的客户服务号码。 NAVAJO (Dine): Taa’dineji’keego shii’kaa’ahdool’wool ninizin’goo, beesh behane’e naal’tsoos bikii sin’dahiigii binii’deehgo eeh’doodago di’naaltsoo bikaiigii bichi’hoodillnii. ––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next page.–––––––––––––––––––––– These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. Don’t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See the next page for important information about these examples. Please note: Coverage examples are calculated based on individual coverage and calculations may not include a coinsurance maximum. ■ Amount owed to providers: $7,540 ■ Plan pays $6,620 ■ Patient pays $920 Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 Deductibles $250 Co-pays $0 Co-insurance $500 Limits or exclusions $170 ■ Amount owed to providers: $5,400 ■ Plan pays $2,000 ■ Patient pays $3,400 Prescriptions $2,900 Medical Equipment and Supplies $1,300 Office Visits and Procedures $700 Education $300 Laboratory tests $100 Vaccines, other preventive $100 Deductibles $250 Co-pays $100 Co-insurance $120 Limits or exclusions $2,930 • Costs don’t include premiums. • Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan. • The patient’s condition was not an excluded or preexisting condition. • All services and treatments started and ended in the same coverage period. • There are no other medical expenses for any member covered under this pla...

Language Access Services. The full spectrum of oral and written services available to provide meaningful access to L&I programs and services for LEP customers, including, but not limited to, in-person interpreter services, telephonic and video interpreter services, the translation of written materials, and services provided by designated bilingual staff.

Language Access Services. SPANISH (Espanol): Para obtener asistencia en Espanol, lIame all-800-788-0616 or TTY /TDD 0-000-000-0000 TAGALOG (Tagalog): Kung kailangan ninyo ang tuIong sa Tagalog tumawag sa 0-000-000-0000 or TTY /TDD 0-000-000 CHINESE <*Jt): ~11~~~*Jt8"J~J3}] '. ifH~1T~-t--'%~ 1-800-757-75850r TTY /TDD 1-'000-000-0000 NAVAJO (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 0-000-000-0000 or TTY/TDD 0-000-000-0000 -~--------To seeexamples of hOJIt)his plan might t'OlJc(r'ostsjor a J-amp!emedica!sitl/xxxxx, J'ccthe 11expt agc.-

Language Access Services. Spanish (Español): Para obtener asistencia en Español, llame al 0-000-000-0000. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 0-000-000-0000. Chinese (中文): 如果需要中文的帮助，请拨打这个号码0-000-000-0000. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 0-000-000-0000. To see examples of how this plan might cover costs for a sample medical situation, see the next section.

Language Access Services. Spanish (Español): Para obtener asistencia en Español, llame al 0-000-000-0000. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 0-000-000-0000. Chinese (中文): 如果需要中文的帮助,请拨打这个号码 0-000-000-0000. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 0-000-000-0000. ----------------------To see examples of how this plan might cover costs for a sample medical situation, see the next page.----------- Having a baby (normal delivery)  Amount owed to providers: $7,540  Plan pays: $5,360  Patient pays: $2,180 Hospital charges (mother) $2,700 Routine Obstetric Care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 Deductible $800 Co-pays $60 Co-insurance $1,290 Limits or exclusions $30  Amount owed to providers: $5,400  Plan pays: $3,610  Patient pays: $1,790 Prescriptions $2,900 Medical equipment and supplies $1,300 Office visits & procedures $700 Education $300 Laboratory tests $100 Vaccines, other preventive $100 Deductible $800 Co-pays $670 Co-insurance $40 Limits or exclusions $280 These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. Don't use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See the next page for important information about these examples. What are some of the assumptions behind the Coverage Examples?  Costs don't include premiums.  Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren't specific to a particular geographic area or health plan.  The patient's condition was not an excluded or pre existing condition.  All services and treatments started and ended in the same coverage period.  There are no other medical expenses for any member covered under this plan.  Out-of-pocket expenses are based only on treating the condition in the example.  The patient received all care from in- network providers. If the patient had received care from out-of-network providers, costs would have been higher. What does a Coverage Example show? For each treatment situation, the Coverage Example helps you see how deductibles, co-payments, and co-insurance can add up. It ...