Common Contracts
3 similar Health Insurance Contract contracts
FOR BCBSMT CUSTOMER SERVICE AND PRIOR AUTHORIZATION FOR CUSTOMER SERVICEHealth Insurance Contract • September 9th, 2024
The In-Network and Out-of-Network Deductibles are separate amounts and one does not accumulate to the other.Any Copayments (except insulin) and/or Coinsurance do not accumulate to
FOR BCBSMT CUSTOMER SERVICE AND PRIOR AUTHORIZATION FOR CUSTOMER SERVICEHealth Insurance Contract • September 20th, 2023
BLUE PREFERRED SILVER PPO 703 COST SHARING REDUCTION - 87% ACTUARIAL VALUE (AV) Annual and Lifetime Plan Maximum: None Benefit Period: Calendar Year The Benefits are subject to the Benefit Period unless otherwise specified. In-Network Out-of-Network Deductible: Individual $700 $2,800 Family $1,400 $5,600 The In-Network and Out-of-Network Deductibles are separate amounts and one does not accumulate to the other.Any Copayments (except insulin) and/or Coinsurance do not accumulate to the Deductible. Deductible Per Visit or Occurrence: Inpatient Admission No Copayment; Deductible and Coinsurance Apply $2,000* Outpatient Surgery – Facility No Copayment; Deductible and Coinsurance Apply $2,000* *The per visit or occurrence Deductible is in addition to The Plan Deductible and any Copayment and/or Coinsurance. Once the Out of Pocket Amount is satisfied, Plan Deductible, per visit or occurrence Deductible(s), Copayment and/or Coinsurance do not apply. Coinsurance: 30% 50% Copaymen
FOR BCBSMT CUSTOMER SERVICE AND PRIOR AUTHORIZATION FOR CUSTOMER SERVICEHealth Insurance Contract • September 20th, 2023
BLUE PREFERRED SILVER PPO 703 American Indian/Alaskan Native Zero Cost-Sharing Annual and Lifetime Plan Maximum: None Benefit Period: Calendar Year The Benefits are subject to the Benefit Period unless otherwise specified. In-Network Out-of-Network Deductible: Individual None None Family None None Coinsurance: None None Out of Pocket Amount: Individual None None Family None None Some Benefits may have payment limitations. Refer to the specific Benefit in this Schedule of Benefits for additional information. In addition:• For Emergency Services provided by an Out-of-Network provider, Benefits will be provided as if such services were provided by an In-Network provider. Nonemergency services for Mental Illness or Substance Use Disorder provided in an emergency setting will be paid the same as Emergency Services.• Out-of-Network providers may bill the Member the difference between the Allowable Fee and the provider’s charge, in addition to any applicable Deductible, Copa
