Blue Cross Health/Dental Plan

Covers ALL Hospitals including Mayo and MOST Doctors

Scroll Down simple Benefits Summary and Monthly Rates

Preventive Health Care - No Deductible

Adult Annual Physicals and Immunizations

Child Wellness Checkups and Immunizations

Independent Lab Tests - Blood, Stool, Urine, Pathology

Pap Smears and Mammograms

Colonoscopies Age 50+

Osteoporosis Screening Women Age 60+

Mental Health - Inpatient 8 days, Outpatient 8 Visits

Alcohol, Obesity, Substance, Tobacco Screening & Counseling

Primary Medical Care - No Deductible

Doctor Visits Unlimited - Family, General, Internal, Pediatrics

Specialist Visits Unlimited - No Referral Required

Allergy Injections Office

Urgent Care Facilities - Extended Hours, Weekends, Holidays

Emergency Room - WAIVED if Admitted

Independent Diagnostic Xrays

Independent Imaging CT, MRA, MRI, PET, Nuclear

SERVICES

No Charge

COPAYS

$35

$50

$10

$55

$300

$50

$200

Annual Deductible $3,000

Applies to Hospital Inpatient, Outpatient Surgery and All Other Covered Services

Then Plan PAYS 75% Next $18,000 - Thereafter Plan PAYS 100% Unlimited

Max Out-of-Pocket $7,500

Includes above Copays, Deductible and 25% Coinsurance

Prescriptions

GENERIC Rxs - No Deductible - Your Copay $10 or Less

Brand Rxs - No Deductible - 15% to 30% Discount

Dental - $750/Person/Year

Preventive Care - No Waiting Period, No Deductible - Plan PAYS 100%

Exams, Xrays, Cleanings, Fluorides

Basic Care - No Waiting Period, $75 Deductible - Plan PAYS 80%

Fillings Silver and White, Extractions Simple and Surgical

.Sample Duval County Monthly Rates - Surrounding Counties Less.

Age 20

Male $132

Female $152

Age 30

Male $178

Female $211

Age 40

Male $224

Female $234

Age 50

Male $290

Female $314

Age 60

Male $461

Female $424

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