Blue Cross MSA plan

Plans Designs


	*11/20/00 - We are suspending the sales of the Blue Cross* *MSA* *pending the passing of legislation extending the MSA laws which are set to expire 12/31/00.*

The new high deductible plan from Blue Cross and Blue Shield qualifies to be used with a Medical Savings Account.

The High deductible plan from Blue Cross and Blue Shield of Illinois pays comprehensive benefits for a variety of services at an affordable cost. This plan gives you freedom to choose any doctor or hospital with 100% coverage after deductible. Coverage is 80% after deductible on inpatient care charges only, from a non-participating provider.

Blue Cross does not act as a Trustee for MSA funds. We can arrange for a trusteee for you.

Plan Highlights
PPO Network	Blue Cross
Maternity	Optional
Well Care	Child
Rx Card	No
Office Copay	No
App. Fee	No
See the Brochure (1.5mb)


	*Learn more about MSA’s in our* *Insurance 101 Section.*


	The following summary is NOT a solicitation to sell you insurance. Solicitations can only be made with state, and insurance company, approved brochures. Information contained in this web may contain generalities or inaccuracies. Please read the brochures and policies for specific limitations and exclusions.


	Plan Summary - MSA Plan

Benefit Description	In Network Benefits	Out of Network Benefits
Calendar Year Deductible	Individual- $2250 Family - $4500	Individual- $2250 Family - $4500
Coinsurance	100%	100% & 80%
Out of pocket limit (plus deductible )	0	No limit
Primary care and specialist Office visits	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Preventive care Coverage for Children to age 16 and limited to $500 per year. General wellness Immunizations	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Other Physician Services Office Visits Surgical procedures Assistant surgeons Anesthesia	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Hospital Services Inpatient Outpatient surgical facility Other Outpatient charges Outpatient X-ray, lab test, diagnostic imaging, radiation therapy.	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 80%
Maternity – Optional coverage. Prenatal and post natal (subject to a 366 day waiting period) Newborn Nursery Charges Delivery and facility charges.	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Other Services Hospice Home Health Care Extended Care facility Medical Equipment and supplies	Subject to deductible, then covered at 100%	Subject to deductible, then covered at 100%
Mental Health Benefits Inpatient Benefits Outpatient Benefits Out of pocket max. does not apply with mental nervous claims.	Inpatient care limited to $10,000 per calendar year. at 100%. Outpatient- $1000 calendar year, at -100%	Same as in net.
Prescriptions Electronic filing at most major Rx.	Covered at 100% after deductible.	Covered at 100% after deductible.
-Outpatient Emergency	Deductible Waived, Covered at 100% for accident or Illness	Deductible Waived, Covered at 100% for accident or Illness
LIFETIME MAXIMUM	$5,000,000	$5,000,000

Preexisting condition clause - Preexisting conditions are those health conditions which were diagnosed or treated by a provider during the 12 months prior to the coverage effective date, or for where symptoms existed which would cause an ordinarily prudent person to seek diagnosis or treatment. Any Preexisting condition will be subject to a waiting period of 365 days.

BLUE CROSS, “MEMBERS-FIRST” PACKAGE OF BENEFITS INCLUDED:

VISION PLAN -PAY JUST $25 FOR AN EYE EXAM FOR GLASSES. DISCOUNTS FROM 100 STATEWIDE CENTERS. NOT COVERED BY PLAN.

DENTAL PROGRAM -REDUCED PRICING FROM MEMBER DENTISTS SAVE 25% OR MORE. NOT COVERED BY PLAN.

HEARING PROGRAM - RECEIVE DISCOUNTS ONHEARING AIDS AND HEARING AID EVALUATIONS PAY AS LITTLE AS $49 FOR A BASIC HEARING EXAM.

OTHER INFORMATION

PREEXISTING CONDITION CLAUSE - 12 MONTHS PRIOR NOT COVERED UNTIL ON PLAN FOR 12 MONTHS.

PRE-CERTIFICATION - NOTIFICATION REQUIRED PRIOR TO ALL ELECTIVE HOSPITAL ADMISSIONS. EMERGENCY AND MATERNITY NOTIFICATION REQUIRED WITHIN 2 BUSINESSDAYS OF ADMISSION.