The Deductible Plan

(Available beginning July 1st, 1999)

With the Blue Shield Deductible Plan, you choose a plan deductible of $1,000 or $2,000 per calendar year. If you choose family coverage, your family deductible is only twice the individual amount, no matter how many people are in your family.

The Deductible Plan provides certain benefits right away, including Preventive Care, office visits with Preferred Providers, Emergency Room visits, and outpatient prescription drugs. For these services, you pay fixed dollar Copays. These Copays do not count toward your plan deductible.

Whenever you use a service that is subject to your plan deductible, you will pay 100% of the costs. The full amount you pay — up to the Allowable Amount for that service — will count toward your deductible. Payments in excess of Allowable Amounts will not count toward your deductible.

After you meet your deductible, you will pay a percentage copayment for most covered services:

• When you use Preferred Providers, Blue Shield pays 80% of the Allowable Amount for covered services — so you pay just 20%.
• When you use Non-Preferred Providers, Blue Shield pays 50% of the Allowable Amount for most services. You pay 50%, plus charges above the Allowable Amount.
• For emergency services, Blue Shield pays 80% of the Allowable Amount, even when you use Non-Preferred Providers.
• For Preventive Care, Preferred Physician office visits, Emergency Room visits, and outpatient prescription drugs, you will still pay fixed Copays after you meet your plan deductible.

Plan Highlights