2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 4. Your Costs for Covered Services
Your costs for other care
Section 4. Your Costs for Covered Services
Your costs for other care
Your costs for other care
Overseas care. Services provided outside the United States, Puerto Rico, and the U.S. Virgin Islands are considered overseas care. Under Standard and Basic Options, we pay overseas claims at Preferred benefit levels. Therefore, the Basic Option requirement to use Preferred providers in order to receive benefits does not apply. See Section 5(i) for specific information about our overseas benefits.
Dental care. Under Standard Option, we pay scheduled amounts for covered dental services and you pay balances as described in Section 5(g). Under Basic Option, you pay $30 for any covered evaluation and we pay the balance for covered services. Basic Option members must use Preferred dentists in order to receive benefits. See Section 5(g) for a listing of covered dental services and additional payment information.
Inpatient facility care. Under Standard and Basic Options, you pay the coinsurance or copayment amounts listed in Section 5(c). Under Standard Option, you must meet your deductible before we begin providing benefits for certain facility-billed services. Under Basic Option, you must use Preferred facilities in order to receive benefits. See page 20 for the exceptions to this requirement.
Overseas care. Services provided outside the United States, Puerto Rico, and the U.S. Virgin Islands are considered overseas care. Under Standard and Basic Options, we pay overseas claims at Preferred benefit levels. Therefore, the Basic Option requirement to use Preferred providers in order to receive benefits does not apply. See Section 5(i) for specific information about our overseas benefits.
Dental care. Under Standard Option, we pay scheduled amounts for covered dental services and you pay balances as described in Section 5(g). Under Basic Option, you pay $30 for any covered evaluation and we pay the balance for covered services. Basic Option members must use Preferred dentists in order to receive benefits. See Section 5(g) for a listing of covered dental services and additional payment information.
Inpatient facility care. Under Standard and Basic Options, you pay the coinsurance or copayment amounts listed in Section 5(c). Under Standard Option, you must meet your deductible before we begin providing benefits for certain facility-billed services. Under Basic Option, you must use Preferred facilities in order to receive benefits. See page 20 for the exceptions to this requirement.