INDIVIDUAL COMPREHENSIVE MAJOR MEDICAL PREFERRED PROVIDER SUBSCRIPTION AGREEMENT IDENTIFIED AS MY LEHIGH VALLEY FLEX BLUE PPOIndividual Comprehensive Major Medical Preferred Provider Subscription Agreement • October 28th, 2016
DESCRIPTION OF COVERAGE: This Agreement sets forth a comprehensive program of inpatient and outpatient facility, professional and ancillary provider benefits provided at network and out-of-network levels of benefits with cost-sharing options such as deductible, copayments and/or coinsurance. Most services are covered at both network and out-of-network levels of benefits. Services received from a network provider are usually provided at a higher level of benefits than out-of-network services, and certain services are covered only when they are received from a network provider. Additionally, certain network services received from a network provider participating at the enhanced value level of benefits are provided at a higher level of benefits than network services received from a provider participating at the standard value level of benefits. Network services are limited to the Community Blue Network, the PremierBlue Shield Preferred Professional Provider Network, the Highmark Blue Shie
