WebBluePreferred PPO Standard Platinum $0 Plan Overview Office Visit Prescription Drug Information Inpatient Coverage Emergency and Urgent Care Maternity Vision Major Dental Care Links Plan Overview Office Visit Prescription Drug Information Inpatient Coverage Emergency and Urgent Care Maternity Vision Routine Eye Exams For Children CoPay: … WebAnnual Prescription Drug Deductible $0 ... BluePreferred PPO Platinum 500 Summary of Benefits . Note: Allowed Benefit is the fee that providers in the network have agreed to accept for a particular service. The provider cannot charge the member more than this amount for any covered service. Example: Dr. Carson charges $100 to see a sick patient.
BluePreferred PPO Platinum 0 Summary of Benefits
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BluePreferred PPO Standard Platinum $0 Claim Forms
WebBluePreferred PPO Platinum 0 Coverage Period: 01/01/2024 - 12/31/2024 Coverage for: Individual Plan Type: PPO The Summary of Benefits and Coverage (SBC) document … WebBenefits for BluePreferred PPO are as follows: Deductible – $100, $300, $500, $750, or $2500. Deductibles are per person, maximum of two per family. Co-insurance – 20% after deductible. 10% for the $100 deductible plan. 10% co-insurance optional for $300 deductible. Annual out of pocket limit for individuals – $2500, $3500, or $5000 ... WebBluePreferred PPO Standard Platinum $0 Coverage Period: 01/01/2024 - 12/31/2024 Coverage for: Individual Plan Type: PPO The Summary of Benefits and Coverage … drive to survive 3