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Employee Groups
Group BasicBlue®
Benefits At a Glance
$1 Million Lifetime Maximum
Inpatient Hospital*
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$500 copayment per admission
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Per day benefit - lesser of charges or $1,000
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30-day maximum per admission
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Maternity (optional for groups with less than 15 employees)
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Infertility/in vitro fertilization ($15,000 lifetime maximum)
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Mental health/chemical dependency - not covered
Outpatient Hospital
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$500 copayment per facility ($200 emergency room copayment - waived if admitted)
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100% benefit (based on The Blue Book allowed charges)
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Maternity (optional for groups with less than 15 employees)
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Infertility/in vitro fertilization ($15,000 lifetime maximum)
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Mental health/chemical dependency - not covered
Physician Services* (In-hospital and Outpatient Hospital)
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100% up to $10,000 maximum per calendar year (based on The Blue Book allowed charges)
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Surgery
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In-hospital visits
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Diagnostic, X-rays and lab work
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Maternity (optional for groups with less than 15 employees)
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Infertility/in vitro fertilization ($15,000 lifetime maximum)
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Mental health/chemical dependency - not covered
Catastrophic Major Medical
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$7,500 deductible
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80% benefit (based on The Blue Book allowed charges)
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Hospital and physician services
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Home health, transplants and hospice care
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Maternity (optional for groups with less than 15 employees)
Ambulance
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80% up to a $300 maximum per calendar year
Other Services*
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50% coinsurance
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Chemotherapy
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Durable medical equipment
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Dialysis
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Physical, speech, occupational, inhalation and cardiac rehabilitation therapy
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Radiation therapy
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Diabetes self-management training
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PKU foods
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Children's preventive care (immunizations not subject to coinsurance)
*Allowable charge coinsurance may be covered under catastrophic major medical.
RIDERS (OPTIONAL)
Physician Office Visits
$35 copayment; maximum $2,500 per calendar year
Prescription Drugs
After a $250 deductible, Arkansas Blue Cross and Blue Shield pays 50% of the next $2,000, then 100% of the next $3,000 per calendar year.
IMPORTANT NOTE:
This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).
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