BlueChoices offers flexible options in benefits, deductibles and provider networks (Participating, Preferred Provider Plan [PPP] and Access). The resulting benefit-deductible-network combinations product a wide range of coverage and premiums. Three products are offered: BlueEssentials, BluePreferred, and BlueClassic. Each product features a choice of three deductibles and four existing provider networks. Benefits are 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.

Each BlueChoices product has 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
• Large groups may choose the "dual" deductible option; where deductibles and maximum coinsurance accumulate separately for in-network and out-of-network services

The in-network office visit benefit for BlueChoices products features different copayment amounts for visits to personal physicians ($20 copay) and visits to specialists ($40 copay).  In general, office visits are comprised of Evaluation and Management (E&M) procedures and select psychiatry and psychotherapy services.

A $10 copay is assessed for the first immunization administration procedure billed for all BlueChoices members. Additional charges for subsequent administration procedures and vaccines supplied on the same day 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.

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 ER charges will be processed at the in-network benefit level, even for out-of-network facilities.

Reimbursement for services and supplies provided to your BlueChoices patients will follow the terms of your existing Participating, PPP and/or Access agreements, depending on the provider network used by your patient's benefit plan. Medical policies, reimbursement policies and preauthorization requirements currently in effect will be followed for BlueChoices products.