myBlue Silver 1604 - BCBSFL

myBlue Silver 1604 schedule of Benefits This schedule of Benefits is part of your Contract, where more detailed information about your benefits can be found. Review this schedule of Benefits carefully; it contains important information concerning your share of the expenses for Covered Services you receive. Amounts listed in this schedule are the Cost Share amount you pay. When a Covered Service is subject to more than one type of Cost Share, the Cost Shares are listed in the order in which they apply to the Covered Service. 0515 0515 1 FINANCIAL FEATURES YOU PAY Calendar Year Deductibles (DED) - Embedded Individual Deductible $6,100 Family Deductible $12,200 Coinsurance (The percentage of the Allowed Amount you pay for Covered Services) 30% Out-of-Pocket Maximums - Embedded Individual Out-of-Pocket Maximum $6,850 Family Out-of-Pocket Maximum $13,700 Medical Pharmacy per person, per month $240 What applies to the out-of-pocket maximum?

myBlue Silver 1604 Schedule of Benefits This Schedule of Benefits is part of your Contract, where more detailed information about your benefits can be found. Review this Schedule of Benefits carefully; it contains important information concerning your share of the expenses for Covered Services you receive. Amounts listed in this schedule are the

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  Schedule, Silver, 1640, Myblue, Myblue silver 1604, Myblue silver 1604 schedule, Bcbsfl

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