Transcription of Highmark Inc., d/b/a HIGHMARK BLUE SHIELD
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Highmark Inc., d/b/a HIGHMARK BLUE SHIELD
BSMUHDHP1200-O 23081 (6/05)Page 1 of 28 HIGHMARK Inc., d/b/a HIGHMARK blue SHIELD ( the Plan ) A Pennsylvania non-profit corporation whose home office address is 1800 Center Street, Camp Hill, Pennsylvania, 17011 Comprehensive Major Medical Preferred Provider HighDeductible Subscription Agreement for Individual Members Utilizing the PremierBlue SHIELD Professional Provider Network and the HIGHMARK blue SHIELD Participating Facility Provider Network, Without a Gatekeeper identified as PPOBlue Required Outline of Coverage YOUR AGREEMENT CAREFULLY-This outline provides a very brief description of the important features of your Subscription Agreement ( Agreement ). This is not the insurance contract and only the actual Agreement provisions will control. The Agreement itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR AGREEMENT CAREFULLY!
BSMUHDHP1200-O Page 3 of 28 total cost of purchase) or, at the option of the Plan, the purchase, adjustment, repairs and replacement of durable medical equipment when prescribed by a professional provider
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