Facility
Surgery
Maternity
Emergency
Preventive
100
What instances do we provide a private room ?
When you must be isolated to prevent contagion, it’s required by law or if only available
100
What is the Calendar Year Deductible?
This amount applies to all surgical procedures under Standard Option
100
What is 48 & 96 hours?
The hours you may stay in the hospital after a regular and/or a cesarean delivery without obtaining precertification.
100
What is 72 hours?
Standard Option member must get care within this time frame to receive accidental injury benefits
100
What is the Blue Health Assessment?
Questionnaire that entitles members to receive special benefit incentives.
200
What is $875.00?
A Basic Option member will pay this copayment amount when they are in a Preferred hospital for 10 days
200
What is Precertification?
The requirement for an inpatient admission which failure to obtain results in a $500 penalty
200
What is the per admission co-payment?
This will be waived when a Standard option member goes to a preferred hospital for delivery
200
What is a Medical Emergency?
The sudden & unexpected onset of a condition or injury that endangers your life or could result in a disability & requires immediate care
200
What are all charges?
Basic Option member pays this for a routine physical when going to a non-participating provider.
300
What are Skilled Nursing Facility benefits?
A member must have Medicare A in order to receive these benefits
300
What are non-covered surgical procedures?
Cosmetic, Reversal of sterilization, standby physicians, LASIK
300
DAILY DOUBLE::What is a patient in their own right?
When a newborn requires definitive treatment, during or after the mothers confinement they become this
300
What is $125.00?
This is the facility co-pay for emergency room visits for Basic option.
300
What is age 22?
Well child benefits are available up to this age as recommended by the American Academy of Pediatrics
400
What is Hospice Care?
An integrated set of services & supplies designed to provide palliative & supportive care to terminally ill patients
400
What are gastric restrictive procedures?
This type of surgery is only covered when morbid obesity is a health problem
400
What is maternity care ?
Prenatal care, delivery & postpartum care.
400
What is an Accidental injury?
Caused by an external force or element such as a blow or fall that requires immediate medical attention
400
What is Osteoporosis?
Screening available to women age 65 and over, or 50-65 with increased risk
500
What is Custodial Care?
Homemaking, bathing, exercising, dressing etc
500
What is reconstructive surgery?
Surgery to correct a functional defect, a congenital anomaly, to restore the mouth to a pre-cancerous state and for all stages of breast surgery following a mastectomy
500
DAILY DOUBLE :: What is 35% of the plan allowance subject to deductible, plus the difference between our allowance and the billed amount?
A Standard option member used a Non-Par doctor to deliver their baby, therefore they are responsible for this
500
What is nothing?
A standard option member will pay this for ambulance services from a preferred provider related to an accidental injury
500
What are routine immunizations?
Hepatitis, Influenza, pneumococcal & tetanus-diphtheria
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