Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Check your cellular data or internet service provider’s plan for details. You’ll only see this if you have the Virtual Visit benefit and an MDLIVE doctor offers the care you need.ġ Internet/Wi-Fi connection is needed for computer access. ![]() When you log in and use our Provider Finder Find a Cost tool, an MDLIVE box result may appear at the top of your provider list. You can meet with the next available professional or make an appointment. Click the Schedule a Virtual Visit button and sign up on MDLIVE's website.Select the Virtual Visits link under the page's Find Care title 2.On the BAM homepage dashboard, select Find All Care under Find Care.Log in to Blue Access for Members SM (BAM SM).They can also write and send prescriptions (when appropriate) to a nearby pharmacy. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.MDLIVE's doctors and therapists can treat many non-emergency medical and behavioral health conditions, like: General Health Before making a final decision, please read the Plan’s federal brochure (RI 71-005). This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. The formulary and/or pharmacy network may change at any time. Enrollment in MPDP depends on contract renewal. The FEP Medicare Prescription Drug Program is a prescription drug plan with a Medicare contract. Your MPDP pharmacy out-of-pocket maximum is part of it, not added to it. ^ What you’ll pay for a 30-day supply of covered drugs.ġ If you have Medicare Part B primary, your costs for prescription drugs may be lower.Ģ On limited occasions, such as for certain drugs that require prior approval, you will need to file a claim for services received from Preferred providers.ģ You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards.Ĥ Eligible expenses for the services of Preferred (In-Network) providers also count toward these limits.ĥ You still have an overall medical out-of-pocket maximum. † Subject to the calendar year deductible: $350 per person or $700 in total for Self + One or Self & Family contracts. Certain out-of-pocket costs do not apply if Medicare is your primary coverage for medical services (it pays first). * If you use a Non-preferred provider under Standard Option, you generally pay any difference between our allowance and the billed amount, in addition to any share of our allowance shown in the table above. 3Ĭost sharing may not apply or may be different if Medicare is your primary coverage (it pays first) $25 copay per treatment up to 12 visits per yearģ5% of our allowance † up to 12 visits per yearĮarn up to $120 for completing three eligible Online Health Coach goals. 3Įarn up to $120 for completing three eligible Daily Habits goals. ![]() The difference between the fee schedule amount and the Maximum Allowable Charge (MAC)Įarn $50 for completing the Blue Health Assessment. $30 copay per treatment up to 12 visits a yearģ5% of our allowance † up to 12 visits a year ![]() Inpatient (Precertification is required) : $450 per admission copay, plus 35% of our allowanceĭiagnostic services (such as sleep studies, X-rays, CT scans) ![]() Inpatient (Precertification is required) : $350 per admission Outpatient facility care: 35% of our allowance † Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance Pre-/postnatal professional care: 35% of our allowance † Tier 5 (Non-preferred specialty): $85 copay Tier 5 (Non-preferred specialty): 30% of our allowance ^ Tier 4 (Preferred specialty): 30% of our allowance ^ Tier 3 (Non-preferred brand): 50% of our allowance Tier 2 (Preferred brand): 30% of our allowance Medical Emergency: 35% our our allowance † $0 for first 2 visits and all nutrition visits Nothing for covered preventive screenings, immunizations and services
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