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COB (Coordination of Benefits) Plan Option
Providing COB coverage, the Blue Cross Prudent Buyer or Arizona Foundation for Medical Care (depending on wich network you chose at open enrollment) provider newtworks reward insureds for utilizing in-network services. A unique plan design for employees who are covered under their spouses benefits as well as their own (dual coverage). The plan is most beneficial if you have children and have coverage under your spouse, who's birthday is first in the year. This plan has no deductible and reimburses benefits at 30% of usual, customary and reasonable charges (UCR).
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2007 Preferred Drug List
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BENEFITS |
NETWORK |
NON NETWORK |
Lifetime Maximum Coverage Amount: |
$5,000,000 |
Out of Pocket Calendar Year Maximum: |
N/A |
Calendar Year Deductible (individual/family): |
No Deductible for Individual or Family |
Office Visit: |
30% |
Emergency Room Co-payment:
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None |
Coinsurance: |
30% |
Hospitalization (facility and practitioner): |
30% |
Routine Annual Physical Exams: |
None |
Mammograms (Age 35+) & Well Woman Exams: |
30% |
Lab Fees: |
30% |
Pregnancy: |
See Office Visits and Hospitalization |
Well Child Care (to age 16): |
See Office Visits and Lab Fees |
Family Planning: |
No Benefits |
Psychiatric/Mental Health, Alcohol, Drug Dependency: |
Covered under The Holman Group |
Therapies (Speech, Respiratory, Occupational, Physical, Chiropractic): |
30% |
Emergency Ambulance Services: |
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30% |
Local Ambulance Transportation
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30% - $2000 Annual Maximum |
Life Threatening Air Ambulance
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30% - $18,000 Annual Maximum |
Durable Medical Equipment Coverage: |
30% - $4,000 Annual Maximum |
Prescription Drugs: |
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None |
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$5 |
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$20 |
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$35 |
last updated: 2.8.10 jll
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