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Plan A: Our most popular plan In-network coverage (1,2)
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Plan B: For the budget minded In-network coverage (1,2)
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Plan C: Our newest plan In-network coverage (1,2)
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Plan A, B & C: Alternative options Out-of-network coverage (1,2)
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Benefit period deductible
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Deductible options: $250, $500, $1,000 or $2,500
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Deductible options $500, $1,000, $2,500, $3,500 or $5,000
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Deductible options: $1,000, $2,500, $3,500 or $5,000
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Same as in-network
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The benefit period deductible is the amount you pay for some services before Blue Advantage pays its portion
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Coinsurance
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80 or 100% (100% coinsurance is not available on the $2,500 deductible option)
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70%
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50%
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Plan A: 70%, Plan B: 60%, Plan C: 40%
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Coinsurance is the percentage of the allowed amounts for covered services that BCBSNC will pay
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Coinsurance maximum
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100% coinsurance plans: $0 80% coinsurance plans: $2,000 per individual, $4,000 per family
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$3,000 per individual, $6,000 per family
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$3,000 per individual, $6,000 per family
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When using out-of-network providers, your coinsurance maximum is twice the in-network coinsurance maximum
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Once your coinsurance maximum is met, Blue Advantage covers 100% of all covered services for the rest of the benefit period
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Lifetime benefits
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Unlimited
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$5 million
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$5 million
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Same as in-network
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A maximum amount paid for covered services which is the extent of the Plan's lifetime liability per member
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Physician office visits
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100% after a $15 copayment for primary physicians (3) or a $30 copayment for specialists (4)
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100% after a $25 copayment for primary physicians (3) or a $50 copayment for specialists (4)
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100% after a $30 copayment for primary physicians (3) or a $60 copayment for specialists (4)
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70% after benefit period deductible
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Primary doctors and specialists (including surgery, lab work, therapy and radiology performed by the same doctor on the same day in office)
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Prescription drugs
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100% after $10 copayment for generic, $35 or $50 for brand-name, or 25% member coinsurance for specialty brand (5)
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100% after $200 deductible per member, then $10 copayment for generic, $35 or $50 for brand-name, or 25% member coinsurance for specialty brand (5)
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100% after $500 deductible per member, then $10 copayment for generic, $35 or $50 for brand-name, or 25% member coinsurance for specialty brand (5)
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Same as in-network, plus the charges exceeding the allowed amount
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No annual limit for generic drugs ($2,000 maximum for brand-name drugs per person per benefit)
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Vision care
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100% after a $15 copayment
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Not available
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Not available
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Not available
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Routine eye exam
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Hospital care
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Inpatient facility, outpatient facility, drugs, blood, supplies, medical care, surgical care, therapy services, diagnostic tests, X-rays and lab work
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Hospital care
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100% with no deductible
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100% with no deductible
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100% with no deductible
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Coinsurance after benefit period deductible
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Outpatient laboratory tests and mammograms performed alone
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Preventive care
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100% after a $15 copayment for primary physicians (3) or a $30 copayment for specialists(4)
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100% after a $25 copayment for primary physicians (3) or a $50 copayment for specialists(4)
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100% after a $30 copayment for primary physicians (3) or a $60 copayment for specialists(4)
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Not available (6)
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Routine physical exam, including gynecological exam; wellchild and well-baby care (including periodic assessments and immunizations)
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Urgent care centers
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100% after a $30 copayment
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100% after a $50 copayment
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100% after a $60 copayment
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100% after same copay as in-network
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Services provided for a sudden or unexpected condition requiring prompt diagnosis or treatment to prevent chronic illness, prolonged impairment or a more hazardous treatment
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Emergency room services
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100% after a $150 copayment (7) (copayment waived if admitted)
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100% after a $150 copayment (7) (copayment waived if admitted)
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100% after a $150 copayment (7) (copayment waived if admitted)
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100% after a $150 copayment (7) (copayment waived if admitted)
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Health care items and services furnished or required to screen for or treat an emergency medical condition until the condition is stabilized
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Ambulatory surgery centers
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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A licensed or certified nonhospital facility which has permanent facilities and equipment for the primary purpose of performing surgical procedures on an outpatient basis and does not provide inpatient accomodations
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Mental health and substance abuse
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50% after benefit period deductible
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50% after benefit period deductible
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50% after benefit period deductible
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50% after benefit period deductible (Plans A & B) 40% after benefit period deductible (Plan C)
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$2,000 maximum per person per benefit period, $10,000 lifetime per person; includes inpatient facility, inpatient professional and outpatient professional
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Other services
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Coinsurance after benefit period deductible
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Durable medical equipment, home health care, and home infusion therapy, hospice care, private duty nursing, ambulance services, skilled nursing facilities (to 60 days per year) and dental accident
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