Special CareSMSingle adults and families |
|
|---|---|
| Monthly cost | $148.70/one adult; $211.70/one adult & child(ren); $297.35/two adults; $360.50/two adults & child(ren) |
| Type of coverage | Traditional Blue Cross & Blue Shield limited benefit plan |
| Eligibility | Family size and income (income review will be waived for individuals transferring from adultBasic by May 2, 2011) |
| Wait period before becoming eligible | None |
| Pre-existing condition rule | Yes |
| Copays | 4 doctor office visits/year at $15 PCP copay/$25 specialist copay |
| Benefits | |
| Doctor office visits | 4 visits/year at $15 PCP copay/$25 specialist copay |
| Hospitalization | limited to 21 days per benefit period |
| Surgery and anesthesia | covered |
| Emergency care | $50 copayment (waived if admitted) |
| Diagnostic services | covered |
| 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 |
For specific information regarding benefits, limitations, and exclusions, please call 1-866-282-2702.
