There are currently three products under the BlueChoices umbrella. These products are BlueEssentials, BluePreferred, and BlueClassic. Each of these products feature a choice of deductibles and existing provider networks (Participating, PPP and Access). The benefits have been designed to provide strong incentives for members to seek services from physicians, other professional providers and health-care facilities contracted with the provider network used by their benefit plan.

All BlueChoices products have the following in common:

• Deductible waived for preventive services received from in-network providers
• No primary care physicians (PCPs)
• No tracking of referrals or callshare arrangements
• No risk withhold

Office Visits

The in-network office visit benefit for our BlueChoices products features different copayment amounts for visits to personal physicians ($20 copay) and visits to specialists ($40 copay). A personal physician is defined as a nurse practitioner or a physician or other professional provider with one of the following primary specialties:

• Family practice
• General practices
• Internal medicine
• Pediatrics
• Obstetrics and/or gynecology

Our online PAR, PPP and Access provider directories now include a specialty selection of "Personal Care Physician" to help you and your patients determine which level of copayment will be assessed.

Other services and supplies (except for immunization and vaccines) are subject to applicable deductible and coinsurance. This is true whether the services and supplies are provided in conjunction with an office service or not. For example: A BluePreferred member sees an in-network personal physician for an injury, receives a tetanus shot and has several x-rays taken. During this visit, the member will incur a $20 office visit copay, a $10 immunization copay (which covers the administration and serum), and his x-rays will be subject to the deductible and coinsurance specified by his plan.

Immunizations

The benefit for eligible immunizations is the same for all BlueChoices members. A $10 copayment is assessed for the first immunization administration procedure billed, e.g., CPT 90471 Immunization administration; one vaccine. Additional charges for subsequent administration procedures and vaccines supplied on the same date of service are covered at 100% of the maximum allowable fee for those services and supplies. These charges are not subject to the member's deductible or coinsurance, even when billed by out-of-network providers.

Emergency room

The emergency room benefit for all in- and out-of-network facilities features a $100 copayment, after which the member's deductible and coinsurance applies. The copayment will be waived if the member is admitted. If the visit is deemed a true emergency, the emergency room charges will be processed at the in-network benefit level, even for out-of-network facilities.

The table on the next page outlines the basic benefit structure for the three BlueChoices products, BlueEssentials, BluePreferred and BlueClassic. Specific benefit information should continue to be verified through Customer Service or Regence Online Services.

Click "Next" below to view a benefit summary.