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Blue Selections Premiere(Oregon)

Plan Overview
Find a doctor in provider directory	Preferred Provider (PPO) Directory
Lifetime benefit maximum	$2 million for each covered family member
Annual coinsurance maximum	$4,000 In-network, $6,000 Out-of-Network
Office visit	$20 co-payment
Annual women's exams	$20 co-payment
Childhood immunizations	$10 co-payment
Well-baby care through age 2	$20 co-payment
Ambulance	80%
Deductibles	$500, $1,000, $2,500, $5,000, $7,500
After medical deductible is met	We pay 80% of eligible preferred provider (In-network) services and 70% of eligible non-preferred provider (Out-of-Network) services
Travel benefit	The BlueCard Program allows you to see any participating Blue Cross or Blue Shield doctor when you travel.

*The Plan Overview is a brief summary of benefits for illustrative purposes only. Download the full brochure for more complete information on benefits.

Plan Highlights

Office visits for a $20 co-payment

How to Use Your Medical Benefit

You pay a $20 co-payment and no deductible or coinsurance for basic services, such as office visits, annual women's examinations (including related Pap smear and routine mammography), allergy shots, childhood immunizations through age 18, and well-baby care through age two.

We pay other services provided by a In-Network provider at 80% after your calendar year deductible is met. Of course, you're not limited to In-Network providers. Once your medical deductible is met, you may seek care from a Out-of-Network provider and we will pay 70% of these costs.

The same services are covered regardless of which provider you choose, but when you use In-Network providers we will pay a larger percentage of your covered expenses.

Full Brochure