Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package Notice About Plan Benefits: No person has the right to receive the Benefits of this plan for services or supplies furnished following termination of coverage. Benefits of this plan are available only for services and supplies furnished during the term it is in effect and while the individual claiming Benefits is actually covered by this Agreement. Benefits may be modified during the term of this plan as specifically provided under the terms of this Agreement or upon renewal. If Benefits are modified, the revised Benefits (including any reduction in Benefits or the elimination of Benefits) apply for services or supplies furnished on or after the effective date of the modification. There is no vested right to receive the Benefits of this Agreement. Notice About Reproductive Health Services: Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at Blue Shield’s Customer Service telephone number provided on the back page of this Evidence of Coverage and Health Service Agreement to ensure that you can obtain the health care services that you need. Notice About Contracted Providers: Blue Shield contracts with Hospitals and Physicians to provide services to Members for specified rates. This contractual agreement may include incentives to manage all services for Members in an appropriate manner consistent with the contract. To learn more about this payment system contact Customer Service. Notice About Health Information Exchange Participation: Blue Shield participates in the California Integrated Data Exchange (Cal INDEX) Health Information Exchange (“HIE”) making its Members’ health information available to Cal INDEX for access by their authorized health care providers. Cal INDEX is an independent, not-for-profit organization that maintains a statewide...
Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package.
Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package High Deductible Health Plan: This health plan is intended to qualify as a “high deductible health plan” for the purposes of qualifying for a health savings account (HSA), within the meaning of Section 223 of the Internal Revenue Code of 1986, as amended. Although Blue Shield believes that this plan meets these requirements, the Internal Revenue Service has not ruled on whether the plan is qualified as a high deductible health plan. In the event that any court, agency, or administrative body with jurisdiction over the matter makes a final determination that this plan does not qualify, Blue Shield will make efforts to amend this plan, if necessary, to meet the requirements of a qualified plan. If Blue Shield determines that the amendment necessitates a change in the plan provisions, Blue Shield will provide written notice of the change, and the change shall become effective on the date provided in the written notice. Important Information Regarding HSAs IFPPPOHSAEOCJ14 IFPPPOHSAEOCJ14
Packaged Plan. This health plan is part of a package that consists of a health plan and a dental plan which is offered at a package rate. This Evidence of Coverage and Health Service Agreement describes the benefits of the health plan as part of the package. High Deductible Health Plan: This health plan is intended to qualify as a “high deductible health plan” for the purposes of qualifying for a health savings account (HSA), within the meaning of Section 223 of the Internal Revenue Code of 1986, as amended. Although Blue Shield believes that this plan meets these requirements, the Internal Revenue Service has not ruled on whether the plan is qualified as a high deductible health plan. In the event that any court, agency, or administrative body with jurisdiction over the matter makes a final determination that this plan does not qualify, Blue Shield will make efforts to amend this plan, if necessary, to meet the requirements of a qualified plan. If Blue Shield determines that the amendment necessitates a change in the plan provisions, Blue Shield will provide written notice of the change, and the change shall become effective on the date provided in the written notice. Important Information Regarding HSAs This plan is not a “Health Savings Account” or an “HSA”, but is designed as a “high deductible health plan” that may allow you, if you are eligible, to take advantage of the income tax benefits available to you when you establish an HSA and use the money you put into the HSA to pay for qualified medical expenses subject to the deductibles under this plan. If this plan was selected in order to obtain the income tax benefits associated with an HSA and the Internal Revenue Service were to rule that this plan does not qualify as a high deductible health plan, you may not be eligible for the income tax benefits associated with an HSA. In this instance, you may have adverse income tax consequences with respect to your HSA for all years in which you were not eligible. IFPPPOHSAEOCJ14 IFPPPOHSAEOC14 NOTICE: Blue Shield does not provide tax advice. If you intend to purchase this plan to use with an HSA for tax purposes, you should consult with your tax advisor about whether you are eligible and whether your HSA meets all legal requirements.
