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Blue Solution PPO: Benefits Summary
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Provides comprehensive major medical protection;
- Available to individuals and families, ages 0-64, not eligible for Medicare;
Note: Family coverage is not available for applicants under the
age of 18. Family coverage includes "individual and spouse," "individual and child(ren)"
and "individual, spouse and child(ren)."
If you are including child(ren) with either parent or elect full family coverage,
one premium amount covers all your dependent children from birth to age 25 (if a
full-time college student), no matter how many children are insured. Upon reaching
the age of ineligibility (19 or 25, depending on academic status), dependent children
may receive guaranteed conversion to their own individual policy with the same benefits
(certain rules apply).
- Choice of deductibles (See Benefits at a
Glance);
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$2 million lifetime maximum;
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Calendar-year deductible;
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Deductible carryover;
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Calendar-year benefit period (Jan. 1 - Dec. 31);
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Coordination of benefits;
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Dependents covered until age 19 or age 25 if child is full-time student; no age
limit for disabled children (Certain rules apply.);
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Age and sex rated (premium based on the age and sex of the oldest person);
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Conditions existing prior to the effective date of the policy are not covered until
it has been in effect for 12 months.
Hospital Benefits
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Operation and recovery rooms (includes outpatient surgery);
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Semi-private room and board;
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Intensive care;
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Required diagnostic X-ray and lab tests;
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Complications of pregnancy;
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Anesthesia services;
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Drugs and supplies;
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Newborn services (unless individual policy);
- Voluntary sterilization (reversal not covered).
Outpatient Benefits
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Physician outpatient care;
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Surgery;
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Radiological therapy;
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Injectable chemotherapy;
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Medical emergencies;
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Outpatient X-ray and lab tests;
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Private-duty nursing (with limitations);
- Drugs and supplies.
Physician Benefits
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Office visits;
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In-hospital visits;
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Surgery;
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Anesthesia;
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Outpatient X-ray and lab tests;
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Complications of pregnancy;
- Durable medical equipment.
Maternity Option (Prenatal/Obstetrics)
This optional benefit is available only to females 18 years of age and older. Maternity
coverage includes:
- Obstetric care
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Physician services;
- Labor and delivery room.
Note: Newborns are automatically added to family policies if the
appropriate forms are filed within 90 days of birth. Individual policies, however,
cover the mother only. If you choose "individual" coverage, any dependents you choose
to add in the future — including newborns — will be medically underwritten, and
the effective date of the coverage will be subsequent to the approval date. This
means — with an "individual" policy — there is no possibility of a newborn being
covered from date of birth.
Newborns will be considered for coverage only after our review of the medical records
from their two-month check up. In network, the rider is subject to your deductible
and coinsurance. (For out-of-network benefits, see "out-of-Network Benefits" below.)
The maternity rider can be added only at the time of application and must be effective
prior to conception. A policyholder who subsequently marries may apply to add maternity
coverage. Application for the maternity rider must be made within 30 days of the
date of marriage and effective prior to the date of conception.
Out-of-Network Benefits
For out-of-network providers, you must satisfy double your in-network deductible
before the insurance plan begins to pay benefits. (For instance, with individual
coverage, if your in-network deductible is $1,500, your out-of-network deductible
will be $3,000.)
Once you've satisfied your out-of-network deductible, any applicable coinsurance
and calendar-year coinsurance maximum amounts are also doubled for out-of-network
providers.
In addition, if you go out of network, you will also be responsible for any "balance
billing" — in other words, the difference between the provider's bill and the Arkansas
Blue Cross and Blue Shield-allowed amount.
Go to the Provider Directory for a complete list of
True Blue PPO providers.
Deductible Carryover
Expenses incurred toward the deductible during the last three months of the calendar
year may also be used to satisfy the deductible for the succeeding calendar year.
Term Life Insurance
USAble Life* is pleased to introduce Life Solutions – a term life insurance program for Arkansas Blue Cross
and Blue Shield individual policyholders. Life Solutions can enhance your existing life coverage – at a price
you can afford. All benefits are paid regardless of other life insurance that you may have.
Critical Illness
Critical Illness Coverage is also available through USAble Life*. Critical Illness Coverage pays a lump sum cash
benefit of $10,000, $20,000 or $30,000 upon the first positive diagnosis of a covered critical illness. This
benefit can help cover the costs associated with recovering from a serious illness – including home health
care, experimental medical care, transportation costs to and from treatment and more.
*USAble Life is an independent company and operates separately from Arkansas Blue Cross and Blue Shield. USAble
Life does not sell or service Arkansas Blue Cross and Blue Shield products. USAble Life is solely responsible for
the term life and critical illness policies referenced here.
How To Apply
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