|
|
| BluePreferred Basic $2,500 |
In-Network |
Out-Of-Network |
 |
Annual Deductible |
Individual: $2,500 Family: $5,000 |
Individual: $5,000 Family: $10,000 |
|
Annual Out-Of-Pocket Limit |
$4,000 per person (Deductible not Included) |
$8,000 per person (Deductible not Included) |
|
Lifetime Maximum |
$3,000,000 |
$3,000,000 |
|
Office Visits |
PCP $30/Specialist 20% |
50% |
|
Prescription Drugs |
$30 Generic Up to $125 Brand |
After submitting a claim, you will be reimbursed for amounts above the $125 maximum, up to the BCBSAZ allowed amount per prescription. |
|
Laboratory and Radiology |
20% |
50% |
|
Annual Physical Exam |
20% (deductible waived) |
Not Covered |
|
Annual OB-GYN Exam |
20% (deductible waived) |
Not Covered |
|
Prenatal / Postnatal Maternity |
Not Applicable |
Not Applicable |
|
Well Baby Care |
20% (deductible waived) |
Not Covered |
|
Outpatient Surgery |
20% |
50% |
|
Emergency Room |
20% plus $150 (waived if admitted) |
20% plus $150 (waived if admitted) |
|
Ambulance |
20% (Deductible Waived) |
20% (Deductible Waived) |
|
Home Health Care |
20% (Up to 3 visits of 2 hours or less per day) |
50% (Up to 3 visits of 2 hours or less per day) |
|
Mental Health Services |
See benefits contract |
See benefits contract |
|
Chiropractic Care |
20% (deductible waived) |
50% (deductible waived) |
|
Acupuncture / Acupressure |
Not Covered |
Not Covered |
|
Inpatient Co-payment |
20% |
50% |
| |
Maternity Care |
Not Covered |
Not Covered |
|
Inpatient Mental Health |
20% (2 admissions, up to a combined total of 30 days. $25,000 maximum benefit) |
50% (2 admissions, up to a combined total of 30 days. $25,000 maximum benefit per person) |
|
Chemical Dependency |
See benefits contract |
See benefits contract |
|
|
QUOTE
APPLY ONLINE
DOWNLOAD APPLICATION
DOCTOR SEARCH
PLAN
BENEFITS PDF
EXCLUSIONS
|
| |
|
About
Blue
Cross
Blue
Shield
of
Arizona
Blue Cross Blue Shield of Arizona, an independent licensee of the Blue Cross Blue Shield Association, is a local not-for profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,500 dedicated employees throughout its Phoenix, Tucson, Tempe and Flagstaff offices.
The company provides health insurance products, services or networks to more than 1.1 million individuals, making it the largest locally based insurance company in Arizona.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
As an active supporter of the community, Blue Cross Blue Shield supports more than 200 organizations statewide through volunteering and contributions.
|
|
|
|
|
