Special CareSM
Single adults and families |
| Monthly cost |
$140.50/one adult; $200.40/one adult & child(ren);
$280.95/two adults; $341.00/two adults & child(ren) |
| Type of coverage |
Traditional Blue Cross & Blue Shield
limited benefit plan |
| Eligibility |
Family size and income |
| Wait period before becoming eligible |
None |
| Pre-existing condition rule |
Yes
(unless transferring from another Blue plan within 30 days)
Coverage excluded for one year for medical condition for which medical advice or treatment was received during the 12 months prior to the effective date of the policy. |
| Copays |
4 doctor office visits/year at $10 copay |
| Benefits |
| Doctor office visits |
4 visits/year at $10 copay for treatment of injury or illness |
| Hospitalization |
limited to 21 days per benefit period |
| Surgery and anesthesia |
covered |
| Emergency accident and medical care |
covered |
| Diagnostic services |
covered up to $1,000 per year |
| Chemotherapy and radiation therapy |
covered |
| Maternity care |
covered |
| Newborn care |
covered for up to 31 days following birth |
| Dental |
not covered |
| Vision and hearing |
not covered |
| Prescription drugs |
not covered |
| Durable medical equipment |
not covered |
| Mental health |
not covered |
| Serious mental illness |
not covered |
| Substance abuse |
not covered |
