American Society of Chartered Life Underwriters. Check benefits, view your member ID card, and more—from anywhere Once you’ve set up your MyBlue account, you’ll want to add the MyBlue AZSM mobile app to your smartphone $50 copay deductible does not apply : Precertification may be required. HSA/[email protected] 1a: No charge; prescription deductible does not apply Tier 1b: $10 copay/30-day supply; prescription deductible does not apply : Not coveredIf you need these services call 1-800-446-8331 (TTY: 711) for BCBSAZ Medicare Advantage or 1-833-229-3593 (TTY: 711) for BCBSAZ Blue MedicareRx (PDP) or 1-800-656-8991 (TTY: 711) for HCA. ABOUT BLUE CROSS BLUE SHIELD OF. amanda. Health Saving Account Employer Contribution Paid over 26 pay cycles to Optum Bank upon activation. Benefits Books. $10 copay/30-day supply; deductible does not apply : 50% coinsurance & balance 90-day supply 3 copays retail and 2 copays mail for tier 1 prescription drugs. Our Member Services Department is open 8 a. Find health insurance plans for all health concerns and budgets for individuals, families, and businesses. Register for MyBlue. Pure Jill Ecovero™ Satin Scenic-Printed Top. For more information about your coverage, or to get a copy of the complete terms of coverage, visit azblue. Your doctor can submit the form and documentation by fax to 602-864-3126 or by email to pharmacyprecert@azblue. receive a bill from a provider for the difference between the provider’s charge. not: to automatically resubmit claims. or password? Don’t have an account? Registration is easy. PHOENIX (3TV/CBS 5) -- Hundreds of thousands of Arizonans are at risk of losing their health care coverage this year. Date of Birth. We're here to help! Timely support for critical care: [email protected]. Call 866-325-1794 to check the status of a request. Networks & Products. Use your Anthem BC OTC benefits card to access hundreds of approved brand name and generic health and wellness items. We would like to show you a description here but the site won’t allow us. The Triple Choice Plan, was created by Blue Cross ® Blue Shield ® of Arizona (AZ Blue) specifically for employees of the State of Arizona. Disclosures for Claims In-Scope for NSA Protections. That's why AZ Blue works each day to ensure all Arizonans have affordable access to the care they need. $500 charge if no precertification for out-of-network services. m. You will pay less if you use a provider in the plan’s network. com. With a mission to inspire health and make it easy, AZ Blue offers health insurance and related services to more than 2 million customers. Take a look at your health spending over the past year and keep in mind things like your deductible, frequency of doctor visits and overall healthcare cost for the year. Secure Portal – BlueDentalProvider 3-8 . com D16804 06/10 16804 0610 10-0450. See or call . Sun Basket® delivers healthy food choices to State employees at a discounted price, offering convenience and simplicity. You will pay less if you use a provider in the plan’s network. Be your healthiest with Blue Cross Blue Shield of Arizona. $20,000/ family . Explore the variety of health insurance options offered by BCBSAZ for individuals and families. com. com. Our sincere thanks to each and every one of you! Blue Cross Blue Shield of Arizona, Phoenix, Arizona. Prescription Drug Plans. Blue365 offers premier health and wellness discounts and is free to join. This plan uses a provider network. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of. Provider Directory. Find health insurance plans for all health concerns and budgets for individuals, families, and businesses. The issues we are experiencing are intermittent, but even one impacted member is too many. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. 10% after Deductible. You have children at home and don’t want to bring them to the doctor’s office with you. com 3-2 . com. The Crossword Solver finds answers to classic crosswords and cryptic crossword puzzles. This plan does not cover services by out -of-network providersIn-network: $3,000/individual or $6,000/family Out-of-network: $3,500 /individual or : $7,000/ family : Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. Member ID. Yes. com2023INDbooksOn. Drugs that are not listed on the formulary below but are considered specific benefit plan exclusions will not be covered (see “What is Not Covered?”). Click the answer to find similar crossword clues . com/NationsBenefits to view eligible items for purchase, download a catalog or request a mailed catalog by calling 602-313-7135 (TTY:711), Monday – Friday, 8:00 am – 4:30 pm. Published: Jan. Explore the variety of health insurance options offered by BCBSAZ for individuals and families. Enroll now to receive electronic remittance advice (ERA) 835. NationsBenefits. m. com 3-7 . $25 - Infant and Well Child Visits (Ages 0-15 months. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and whattools on the azblue or azbluemedicare secure provider portal, or by calling the automated interactive voice response (IVR) system at 602-864-4320 or 1-800-232-2345 (for Medicare Advantage, call 1-800-446-8331). This plan uses a provider network . A simplified document that summarizes your health benefits and coverage. PCPs participating in the BCBSAZ Patient Centered Medical Home (PCMH) program can now receive partial prepayment of their estimated annual quality incentive. 50% coinsurance & balance bill : Precertification may be required. This plan uses a provider network. Access savings on premiums, deductibles and copays and enroll in less than 10 minutes. BCBSAZ has addressed Mr. m. The Pharmacy Prior Authorization Request Form is listed under the Forms and Resources section of the page. Explore the variety of health insurance options offered by BCBSAZ for. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and whatWhen it comes to living your healthiest life, we understand that access to routine and emergency healthcare is critical to your wellbeing. The Triple Choice Plan, was created by Blue Cross ® Blue Shield ® of Arizona (AZ Blue) specifically for employees of the State of Arizona. You will pay less if you use a provider in the . If you have any questions about our transition policy or need help asking for a formulary exception, call BCBSAZ. 1-877-475-8440 for a list of in-network : providers. We now use a secure digital EFT form that may only be accessed by someone with the “Financial Manager” user role. You will pay less if you use a provider in the plan’s network. If you have any questions, please call us at 800-928-1558 (TTY: 711). m. m. Yes. ERA Enrollment Form ERA Enrollment Instructions. Browse our plan options or talk to our team to learn more. The prescription drug benefit information provided through the use of this website is subject to all terms, conditions, limitations and. Skip To Main content. Yes. You will pay less if you use a provider in the plan’s network. Securely download your document with other editable templates, any time, with PDFfiller. Find health insurance plans for all health concerns and budgets for individuals, families, and businesses. Members with diabetic or. Not Yet a Member?Access the group’s TPA information online via the azblue. The MyBlue AZ mobile app by Blue Cross Blue Shield of Arizona is designed to help you use and manage your health plan. Click on the Resource Center tab, select Pharmacy, then select View resources for Standard Pharmacy Plans. Electronic Services 3-9 . to 8 p. CLINICAL RAPID RESPONSE. Effective 10/2020Register for the employer portal access to manage your employee roster, benefits, and bill payments, or view/order ID cards. For that extra level of “whole person” support for your patients: CM@azblue. L. providers. $697. Remember Username. To find a Blue Cross Blue Shield of Arizona health insurance plan or to find out if you are eligible for a Medicaid plan, visit azblue. , Monday through Friday from April 1 to September. Most in-network Arizona providers located only in Maricopa County. See or call 1-877-475-8440 for a list of in-network providers. Password is required Browse our plan options or talk to our team to learn more. Instructions on where to submit the form and the required information is included within the form itself. Preventive care; primary care and specialist office visits; tier 1 prescription drugs; specialty drugs ; urgent care visits; mental health office visits; hospiceCorporate Health Services (CHS) Through CHS from Blue Cross Blue Shield of Arizona (BCBSAZ), you have access to BCBSAZ’s provider networks where you have access to BCBSAZ-contracted doctors, hospitals and other healthcare providers. Preventive care ; primary care and specialist office visits; tier 1 prescription drugs; urgent care visits; mental health office visits; hospice services ; child eyeTake care of your health and earn rewards. Be your healthiest with Blue Cross Blue Shield of Arizona. 01/31/2024. Our member services team is ready to answer your questions and assist you whenever you need it. com2023INDbooksOn. 1-866-422-2729. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. com. Find health insurance plans for individuals and families with Blue Cross Blue Shield of Arizona and get coverage that fits your life and budget. Provider Resources at azblue. Explore the variety of health insurance options offered by BCBSAZ for individuals and families. Medicare Supplement Outline of Coverage - 2023 (effective April 1, 2023) (Opens in a new tab) Medicare Supplement Rate Information - 2023 (effective April 1, 2023) (Opens in a new tab) Choosing a Medigap Policy - 2023 (Opens in a new tab); Important information regarding Plans C & F (Opens in a new tab)Blue Cross Blue Shield of Arizona Reduces Premiums for 2024 ACA Individual Plans. m. We can move fast on pre-authorizations required for testing and even accelerate access to specialty care. amanda. Get an overview of our networks and associated benefit plans. Shop Plans 1-888-288-4398, TTY: 711. doxo is the simple, protected way to pay your bills with a single account and accomplish your financial goals. Tier 1a: $3 copay/30 day : supply & balance bill , deductible does not apply Tier 1b: $10 copay/30 day supply & balance bill , deductible does not applyPublished: Apr. gov 2021. For Media Inquiries Only: Bashas' Support CenterWe would like to show you a description here but the site won’t allow us. The SBC shows you how you and the plan would share the cost for covered health care services. BlueDental Technical Support. Request information about our health insurance plans and services. Medicare Advantage. See or call 1-877-475-8440 for a list of in-network providers. Crew J. To learn more, visit azblue. Our Triple Choice Plan was developed exclusively for State of Arizona employees. You can view For more information about your coverage, or to get a copy of the complete terms of coverage, visit azblue. Premiums, out-of-network precertification penalty charges, balance-bills, and costs for health care this plan doesn’t cover. Blue Cross ® Blue Shield ® of Arizona (AZ Blue) is committed to helping Arizonans get healthier faster and stay healthier longer. See or call 1-877-475-8440 for a list of in-network providers. No software installation. This plan uses a provider network. We truly appreciate the amazing support of our network providers in caring for so many people affected by COVID-19 across Arizona. Prescription Drug Plans. , an independent licensee of the Blue Cross Blue Shield Association (“we” or “us” or “our”). Fill out this form and one of our Medicare experts will reach out to you. Blue offers HMO & PPO Med Supp, Medicare Advantage and Prescription Drug Plans to fit your lifestyle and your budget. com. Most in-network Arizona providers located only in Maricopa County. Complete the required fields, including your BCBSAZ member ID, then click “Next. This will make it easier for you to purchase the items you need to personalize your care. BCBSAZ 10-2021 . If you have questions, contact our EFT team at EFT@azblue. Stay informed on Covid-19 resources and vaccines. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. Blue Cross Blue Shield of Arizona). In-network: $5,000/individual or $10,000/ family : Out-of-network: $10,000 /individual or . It’s a handy solution for when: You can’t fit a doctor’s visit into your schedule, or you’re having problems making an appointment. Your combined medical expenses have reached $3,000. If you have a question about your health, Member Services can help you, call us at 1-800-322-8670 (TTY 711). For more information about your coverage, or to get a copy of the complete terms of coverage, visit azblue. Call: 866-325-1794. About Us. See or call 1-877-475-8440 for a list of in-network providers. comDefinition. A member may appoint any individual, such as a relative, friend, advocate, an attorney, or. Associated Students of California Lutheran University (Thousand Oaks, CA)Three children have become adults since a phone call with Jo Rowling, containing one small clue, persuaded me that there was more to Snape than an unchanging costume, and that even though only three of the books were out at that time, she held the entire massive but delicate narrative in the surest of hands. $10 copay/30-day supply; deductible does not apply : 50% coinsurance & balance 90-day supply 3 copays retail and 2 copays mail for tier 1 prescription drugs. (602) 370-9513. ☆☆☆☆☆. You pay $20 and your insurance pays $80. See or call 1-877-475-8440 for a list of in-network providers. to 8 p. Employers. Secure Portal – azbluemedicare. Request a Proposal Call (844) 422-2729. An independent licensee of the Blue Cross and Blue Shield Association. Blue Cross® Blue Shield® of Arizona pays you for taking care of your health. Access our healthcare provider resources for insurance eligibility, health insurance card questions, prior authorization, appeals and grievances and more. For more information about your coverage, or to get a copy of the complete terms of coverage, visit azblue. Explore pharmacy resources for prescription drug coverage, drug prices & lists and various plans for individuals, families and employers. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and whatUsername is required. Incomplete forms or. Details specific changes made to plans at the start of each plan year. For help with patient eligibility, benefits, prior authorization, claim status, and fee schedule information: 602-864-4320 1-800-232-2345. Register to learn about plan options in your area. You’d expect to have a $0 deductible, a $0 copay for Tier 1a prescription drugs (most commonly used generic drugs), a $0 copay for your first two visits to your primary care provider (PCP), and a $5 copay per visit with BlueCare Anywhere, our. Amanda Siedler. Be your healthiest with Blue Cross Blue Shield of Arizona. Internal study conducted by Gympass with global clients to understand increase in workforce physical activity over 3 years. We are excited about the future — that’s why we’re. m. is an independent and separate company contracted with Blue Cross Blue Shield of Arizona (AZ Blue) to provide health and wellness services to BCBSAZ members. com2022INDbooksOn. $20,000/ family . Click on the link to shop and compare plans, grab a FREE quote, and sign up for coverage. grievance process by completing and submitting this form. You will pay less if you use a provider in the plan’s network. You will pay less if you use a provider in the plan’s network. 1,100. See or call 1-877-475-8440 for a list of in-network providers. To get updated information about the drugs covered by Health Choice, call Member Services toll-free at 1-800-322-8670 (TTY 711), 8 a. . Limit of 20 chiropractic visits per member/calendar year. Solve your "AZURE" crossword puzzle fast & easy with the-crossword-solver. Username. Our team of experts will be happy to assist you. About Us. Shop Plans 1-833-229-3593. Try Now!and you may wish to look there before calling. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Security Check. Network Name: The network of providers for your coverage. Nurses are available 24/7 and we offer service in a variety of languages. OK. With a mission to inspire health and make it easy, AZ Blue offers health insurance and related services to more than 2 million customers. ☆☆☆☆☆. You will pay the most if you use an out-of-network provider, and you might . Password is requiredMember Log In Access your account here if your plan is through an employer, the Affordable Care Act (ACA) on- or off-exchange, or Medicare supplement. com. Confidential Information Release Forms alone do not grant authorization to your representative to file appeals on your behalf. com. 30% Off Select Men’s and Women’s Styles plus Free Shipping. We're here to help! Timely support for critical care: rapidresponse@azblue. Medicare Prescription Drug Plan. , 7 days a week or you may receive free help and information from:Wellness Benefits at Your Fingertips We want to make using your wellness benefits as easy as possible. Be your healthiest with Blue Cross Blue Shield of Arizona. Box 52033 Phoenix, AZ 85072-2033. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. Contact BCBSAZ today to learn more about our health insurance plans for individuals and families, and for businesses of all sizes. Help is available — contact us at 1-888-288-4398, TTY: 711 or call your insurance agent. 5, 2023 at 7:51 PM PST. The Crossword Solver found 21 answers to "aclu", 3 letters crossword clue. If you have one of the plans listed below, please click the link to access your login portal. Mountain Standard Time (MST)Get Started Today! Click the button below to login to your MyBenefits Portal, or call us at 866-413-2582 (TTY: 711). We. It’s a handy solution for when: You can’t fit a doctor’s visit into your schedule, or you’re having problems making an appointment. Note:You may file a Grievance verbally (over the phone) by calling BCBSAZ Health Choice Pathway at 1-800-656-8991. See easy explanations for common insurance terms on page 12. Register to use the CVS Mail Service Pharmacy or order a refill by mail. Find health insurance plans for all health concerns and budgets for individuals, families, and businesses. Prior authorization requests are reviewed within 10 business days for standard requests. com2023INDbooksOn. Check your listing for accuracy and find in-network referrals for your patients. It affects how we think, feel, and act. Additional Resources. From stress to sleep, diet to exercise, Sharecare will help you identify the areas impacting your health and teach you how to change them. See or call 1-855-PROSANO or 1-855-776-7266 for a list of in-network providers . ASCLU. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Details specific changes made to plans at the start of each plan year. com. Pure Jill Embroidered Popover Top. ProviderDisputes@azblue. Password1. /family ; Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. Contains a full breakdown of payment and coverage information. This plan uses a provider network. Each provider visit counts only as one visit or screening for a $25 gift card. You have children at home and don’t want to bring them to the doctor’s office with you. to 8 p. We're here to help! Timely support for critical care: rapidresponse@azblue. Yes. See our FAQ pages to learn more about doxo. You will pay less if you use a provider in the plan’s network. For general definitions of common terms, such as allowed amount , balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. Media Resources. November 1, 2023. Access savings on premiums, deductibles and copays and enroll in less than 10 minutes. That’s why SelectHealth Medicare members receive all of their wellnessGeneral Requirements (Applicable to All Medical Necessity Requests) For initial therapy, one of the following: o Prescriber attests dosing is in accordance with the United States Food and Drug Administration (FDA) approvedTriple Choice Plan Provider Directory. receive a bill from a provider for the difference between the provider’s charge. Most in-network providers located only in Maricopa County. You will pay less if you use a provider in the plan’s network. com or call (844)-756-2583. Please see the "EEO Is the Law” poster and supplement, and our EEO Policy Statement. Equitable Group Life, Disability, Critical Illness, and Accident Insurance products in the state of Arizona are issued by Equitable Financial Life Insurance Company of America, which has sole responsibility for its insurance and claims-paying obligations for such products. *Premium price shown is based on a. Members with Classic HMO, Plus HMO, and BlueJourney PPO plans. Specialist visit In-network: $3,500/individual or $7,000/ family Out-of-network: $4,000 /individual or : $8,000/ family : Generally, you must pay all of the costs from providers up to the deductible Yes. m. Learn about the benefits of our plans and how to enroll. Do not submit a new claimWe would like to show you a description here but the site won’t allow us. siedler@azblue. Members with Classic HMO, Plus HMO, and BlueJourney PPO plans. com 1-877-475-8449. NationsBenefitsPublished: Jan. You will pay the most if you use an out-of-network provider, and you might . azblue. Find, compare and buy affordable, comprehensive health insurance. Get in touch with our Support Team at 602-864-4262, and press option 2 or email [email protected] understand that consent is not a condition of purchase. If you have questions or concerns about your rights and protections, please call BCBSAZ Health Choice Pathway Member Services at 1-800-656-8991,711, 8 a. This plan uses a provider network. | | | | | | | | | |Sildenafil (Viagra, Revatio) is a moderately priced drug used to treat erection problems in men. We would like to show you a description here but the site won’t allow us. For help with patient eligibility, benefits, prior authorization, claim status, and fee schedule information: 602-864-4320 1-800-232-2345. Changing your habits is the first step in lowering your RealAge—and improving your health. How to Get More Information About Your Rights. • Prior Authorization requests are reviewed within 10 business days for standard requests. Amanda Siedler. 50,000 in-network pharmacies. We're here to help! Timely support for critical care: [email protected]. Blue Cross Blue Shield of Arizona Reduces Premiums for 2024 ACA Individual Plans. A: If your purchase amount is more than the amount you have left to spend on your benefits card, you will need to pay the difference using another form of payment. Brokers. , Monday-Friday (except holidays)Cannot complete your request. We would like to show you a description here but the site won’t allow us. See or call . In order for us to process your request, please confirm that the following. Get the most from your Golden Years. In-network: $2,000/individual or $4,000/ family Out-of-network: $2,500 /individual or : $5,000/ family : Generally, you must pay all of the costs from providers up to the deductible Register at azblue. 23rd Ave. com. Easy access to over 2,000 benefit programs and resources that empower older adults, people with disabilities, and caregivers. Object moved to here. You will pay less if you use a provider in the plan’s network. • View medical and dental claim information. PREVENTIVE CARE. siedler@azblue. siedler@azblue. – 8 p. You will pay the most if you use an out -of-network provider, and you mightForms. receive a bill from a provider for the difference between the provider’s charge. This plan uses a provider network. President and Chief Executive Officer. Yes. For more information about your coverage, or to get a copy of the complete terms of coverage, visit azblue. Member Services can be reached at 480-937-0409 (in Arizona) or at our toll-free phone number at 1-800-446-8331 (TTY users should call 711). Group. You have 60 days prior to losing your coverage to apply. Be your healthiest with Blue Cross Blue Shield of Arizona. Find the right plan for your healthcare needs today. BCBSAZ -TPA co administered plansGet a Quote Call (844) 422-2729. You may also contact us by e-mail at HCHComments@azblue. Media Resources. See or call 1-877-475-8440 for a list of in-network providers. The prescription drug benefit information provided through the use of this website is subject to all terms, conditions, limitations and exclusions of the member's benefit plan. Mental wellbeing support. We're here to help. Contains a full breakdown of payment and coverage information. Find health insurance plans for all health concerns and budgets for individuals, families, and businesses. Amanda Siedler. If you can’t confirm eligibility online, please email us at ProviderHelp@azblue. See below for more information. Blue Medicare Wellness Rewards SM. (866)-325-1794. Take healthy steps to earn My Health Pays™ rewards. Member Experience Advisors are available 24 hours per day, 7 days per week, 365 days per year. com, or call 602-864-5440 to let us know the nature of your request. Generally, you must pay all of the costs from providers up to the deductible amountYes. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Easy access to over 2,000 benefit programs and resources that empower older adults, people with disabilities, and caregivers. Find health insurance plans for all health concerns and budgets for individuals, families, and businesses. Some drugs require precertification or a formulary exception and won’t beMedicare Supplement. com secure provider portal homepage, using the “Eligibility and Benefits Search” tool. Yes. Find the right plan for your healthcare needs today. You will pay less if you use a provider in the plan’s network. AZ Blue, a non-profit company, is an independent licensee of the. 30% coinsurance after deductible for medical telehealthYou can update your address and payment methods, manage your medication reminders, contact list, your allergies and conditions, and more. BlueDental Prime PPO Classic Summary of Benefits and Member Copayments . Daily, 8 a. You can viewShop Plans Call 1-844-756-2583. Small Business (2-50 Employees) Mid-Sized Business (51-300 Employees) Large Business (301+ Employees) Specialty Coverage. You will pay the most if you use an out-of-network provider, and you might . Call 602-313-7135 (TTY:711), Monday – Friday, 8:00 am – 4:30 pm. DISCLAIMER: By submitting your information you agree that Blue Cross Blue Shield of Arizona or an authorized representative, may contact you at the above-listed email or phone number. You will pay the most if you use an out -of-network provider, and you might receive Provider FAQs – Member Account and Prefix Updates (01/10/2023) 2 $15 copay/30-day supply; deductible does not apply : 50% coinsurance & balance 90-day supply 3 copays retail and 2 copays mail for tier 1 prescription drugs. com or call (844)-756-2583. ComPsych ® GuidanceResources ®. Prior Authorization requests are reviewed within 10 business days for standard requests. Click the button below to login to your MyBenefits Portal, or call us at 866-413-2582 (TTY: 711). You’ll use this network name when searching our Find a Doctor catalog. com). Interactive Voice Response (IVR) System 3-11. Explore the variety of health insurance options offered by AZ Blue for individuals and families. You will pay less if you use a provider in the plan’s network. Child must receive at least six well child, EPSDT* visits prior to child’s 15 month birthday)Support for Mental Health. Virtual rewards will be sent by Blue Cross Blue Shield of Arizona. Becoming a BCBSAZ network provider starts with the contract request and credentialing process. com 1-877-475-8449. Garmin GoPro. AZ Blue Enrollment: Call us at (888) 288-4398; TTY: 711, Monday thru Friday 8 a. See or call 1-877-475-8440 for a list of in-network providers. com/MyBlue 3 STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 Quick contacts 2 Review your member ID card 4 Sign up for your MyBlueSM account 5 Know how your plan works 6Page 1 of 10 Even though you pay these expenses, they don’t count toward th Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Blue PPO Gold Statewide Coverage Period: On and after 01/01/22New Over-the-Counter and Blue Medicare Health Rewards.