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SuperBlue® Plus 2008

SuperBlue Plus 2008

Individual Product Enrollment Form Direct Pay SB 2008 Summary Of Benefits Pay It Easy Brochure View Federally Mandated "Shopper" Summary of Benefits and Coverage

Our SuperBlue® Plus 2008 Plan is a Preferred Provider Organization (PPO) plan with a full range of benefits, including a $25 Office Visit Co-Pay, various deductible options, preventive and well child care benefits and an annual routine exam to keep you healthy. The SuperBlue® Plus 2008 Plan is designed to be a comprehensive medical policy.

Attractive features include:

• Annual out-of-pocket maximum.
• 50/50 prescription drug card coverage with no annual deductible.
• 100% emergency ambulance.
• An extensive network of providers. Highmark Blue Cross Blue Shield West Virginia has nearly 5,000 Preferred Provider locations statewide.
• The Blue Card PPO Program which allows members to travel outside the service area and still receive high level benefits when utilizing the services of more than 385,000 Preferred Providers nationwide.
• Guaranteed Renewal that automatically renews monthly as long as you pay premiums when due.
• Program of available discounts from major optical retailers.
• Maternity and Newborn Services are covered when purchasing optional Maternity Services Rider.

This PPO plan gives you access to a nationwide network of preferred providers contracted by Highmark Blue Cross Blue Shield West Virginia. PPO providers agree to special pricing and utilization review arrangements to help contain the cost of care. By seeking care from Highmark Blue Cross Blue Shield West Virginia preferred providers, you can receive the highest level of benefits under your plan. Covered services received from non-network providers are reimbursed at a lower level of benefits.

SuperBlue® Plus 2008 for individuals provides high quality, cost-effective health care coverage with flexibility. In addition to selecting from five deductible options, you are free to seek treatment from any doctor or hospital you choose.

Deductible Options:

$500 $1000 $1500 $2500 $5000
Plan pays 80% after deductible and co-pay with a co-insurance limit of $3000 for individual and $6000 for family; then 100% after.

Services provided outside of the Preferred Provider Network are covered at 60% of our Allowance.

This summary does not constitute an insurance contract and is intended only to provide a brief overview of the SuperBlue Plus program. The actual terms, conditions and limitations of coverage are contained in the Individual Contract. They may vary and are subject to change without notice.

For more information, call your independent health agent or toll-free 1-888-644-BLUE, or 1-888-644-2583.