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What is the the coverage on artificial insemination, in-vitro fertilization (IVF) procedures, such as GIFT (Gamete Intrafallopian Transfer) or ZIFT (Zygote Intrafallopian Transfer), and all related services, and any other assisted reproduction procedure?
We unfortunately do not cover it.
Blue Dental pediatric benefits are included in all "____________________________________"
Blue Dental pediatric benefits are included in all Blue Cross stand-alone dental products
Hospital Recovery Insurance
Eligible Issue Ages: "__________"
Critical Illness
Eligible Issue Ages: "___________"
Personal Accident
Eligible Issue Ages: "__________"
Hospital Recovery Insurance
Eligible Issue Ages: 18 through 85
Critical Illness
Eligible Issue Ages: 18 through 70.
Personal Accident
Eligible Issue Ages: 18 through 74
ABA treatment is available to children through the age of "______"
This limitation does not apply to:
> "_____________________________"
> "_____________________________"
ABA treatment is available to children through the age of 18.
This limitation does not apply to:
• Other mental health services to treat or diagnose ASD
• Medical services, such as physical therapy, occupational therapy, speech therapy, genetic testing or nutritional therapy used to diagnose and treat ASD
Members must be age "______________" on the effective date to be eligible for pediatric dental coverage.
Members must be age 18 or younger on the effective date to be eligible for pediatric dental coverage.
Personal Accident (LS) Annual Deductible
• $0 — not available for Benefit Banks over $ "______" (individuals) or $ "______" (couples/families) OR
• $"_______"
Personal Accident (LS) Annual Deductible
• $0 — not available for Benefit Banks over $ 15,000 (individuals) or $ 25,000 (couples/families) OR
• $500
Maternity care and all related services when provided by the participating attending physician or participating certified "________" must be overseen by a participating "_________"
Maternity care and all related services when provided by the participating attending physician or participating certified nurse midwife must be overseen by a participating OB/GYN
STAND-ALONE VISION
The product has 2 different types of rates:
o "________________________________"
o "________________________________"
STAND-ALONE VISION
The product has 2 different types of rates:
o Annual premium rate for a one-time payment for the year
o Monthly premium rate for ongoing monthly payments
Hospital Recovery
Daily Benefit Amount:
You choose an amount between "____" and "____", in "_____" increments
Hospital Recovery
Daily Benefit Amount:
You choose an amount between $100 and $900, in $10 increments
Death of Policy Holder
Effective Date Options
• "__________________"
• "__________" following the date of application
• Regular effective dates:
Applies between 1-15 –> effective 1st of the "___________________"
Applies between 16-31 –> effective 1st of the "___________________"
Death of Policy Holder
Effective Date Options
• Day after loss of coverage date,
• 1st of the month following the date of application
• Regular effective dates:
Applies between 1-15 –> effective 1st of the following month
Applies between 16-31 –> effective 1st of the 2nd month following
STAND-ALONE VISION
Refunds are allowed by "________________________________________________________"
STAND-ALONE VISION
Refunds are allowed by request provided no benefit utilization has taken place for which premium was paid
Critical Illness Insurance pay what percentage for these services:
Skin Cancer
Heart Attack
Major Organ Failure
Carcinoma in Situ
Critical Illness Insurance pay what percentage for these services:
Skin Cancer 5%
Heart Attack 100%
Major Organ Failure 100%
Carcinoma in Situ 25%
If the request to cancel coverage occurs within 10 days of the effective date "__________________________
_____________________________________________________________________________________________________"
If the request to cancel coverage occurs within 10 days of the effective date, the subscriber will receive a refund of their premium and the contract will be voided from the effective date, resulting in not having issued any coverage
Lenses (not contact lenses)
The lenses may be colorless or have "_____" or "______" if therapeutically necessary. The lens blank of a standard lens must not exceed "______" in diameter.
Lenses (not contact lenses)
The lenses may be colorless or have rose tints #1 or #2 if therapeutically necessary. The lens blank of a standard lens must not exceed 60 mm in diameter.
Hospital Recovery Insurance
Optional Benefit Riders:
>"___________________"
>"___________________"
>"___________________"
Hospital Recovery Insurance
Optional Benefit Riders:
> Emergency Room & Ambulance Benefit
> Major Diagnostic Exam Benefit
> Rehabilitation Facility Benefit