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Catamount BlueSM Benefits: See the Outline of Coverage for a plan overview, or the Certificate of Coverage for details. Highlights: Office Visits: $10 co-payment per visit Preferred Providers: Use our provider directory (2MB PDF) to locate Preferred providers. Preventive Care: 100% coverage Prescription Drugs: Three tier program with certain prior approval, step therapy, and quantity limits. Emergency Care: Covered when condition is a true emergency. Hospitalization: Precertification required. Call 1 800-922-8778 two weeks prior to scheduled admission. Mental Health and Substance Abuse: Prior approval required. Call 800-395-1356 Chronic Care: A special program to help members get the care they need. Pregnancy: Enroll in Better Beginnings Exclusions: Consult a list of services and supplies not covered. Waiting Period: Some Pre-Existing Conditions require a 12 month waiting period. Using Your Benefits Deductible: $250 deductible - individual, $500 - two-person/family (when you use a Preferred Provider). Coinsurance: After meeting deductible, we pay 80% of the Allowed Price, while you pay the other 20% Out of Pocket Limit: $800 individual, $1600 two-person/family (when you use a Preferred Provider). Prior Approval: Benefits for certain services, drugs, and supplies are provided only if Prior Approval is obtained first. Out of State & Worldwide Coverage: the BlueCard program lets your coverage travel with you. Family Changes: a marriage, civil union, birth, or adoption requires written notification. Other Benefits Discounts: BlueExtras offers discounts on health products and services. Health Information: a 24 hour nurse line, the Healthwise Knowledgebase and Healthcare Advisor provide detailed healthcare information. Secure Member Site: Log in to check claim status or look up your health plan benefits. |
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