BLUE CROSS BLUE SHIELD PLAN

  • Preferred Provider Organization – benefits for both in-network and out-of-network services
  • Deductible and co-insurance plan

  • RX would be paid at 100% once out of pocket $1750.00 which includes $450.00 deductible, member’s coinsurance and any copays (which would include RX copays). 

  • No referrals required

  • Extensive Network of Preferred Providers
  • Annual well care visits covered
  • Annual vision exam covered (subject to deductible)

Blue Cross Blue Shield Group Number: 81009
Member Service phone number: 1-800-565-9140
Blue Cross Blue Shield website address: www.bcbst.com

BCBS Plan Document

BCBS Summary of Benefits of Coverage

BCBST Evidence of Coverage 2023










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