To take full advantage of your Active Choice plan, and avoid unnecessary costs, it's important for you to know how your plan works.
Your Active Choice plan divides covered services into three categories. The amount you are responsible for paying depends in part on the category the service is in.
- Category one: Preventive care
- Preventive services: Routine physical exams, well-baby care, immunizations
- Outpatient and professional services: Office visits, diagnostic testing
- After first dollar amount is spent, you are responsible for charges until you reach your copayment maximum
- Category two: Hospital services
- Outpatient and inpatient services: Surgeries, emergency room visits, renal dialysis, chemotherapy
- Category three: Prescription drugs
- Copays vary, depending on whether it's a generic or brand-name drug
Refer to your Certificate of Insurance for more details about your copayment and coinsurance responsibilities.
First dollar services coverage is like having a personal fund with a set amount of dollars for health care. "First dollar" means that you do not have to satisfy a deductible before benefits are provided.
Services that qualify for first dollar coverage are preventive care and outpatient professional, hospital and diagnostic services listed under "first dollar 100% services" in your Certificate of Insurance.
For these services, the plan pays 100% of the allowable amount until the first dollar amount stated in your Certificate of Insurance is used.
After the first dollar amount is used, you pay all charges until your maximum copayment responsibility amount has been reached.
Once your maximum copayment responsibility amount has been reached, the plan pays 100% of the allowable amount for subsequent services.
(This does not apply to outpatient or office mental health services and substance abuse care for other than severe mental illnesses or serious emotional disturbances of a child. For these services, you continue to be responsible for payment of charges after the maximum calendar-year copayment has been reached.)
For all services other than first dollar 100% services see your Certificate of Insurance for details.
Note that copayments and charges for services that are not included in your maximum calendar-year copayment continue to be your responsibility after you reach your maximum calendar-year copayment responsibility.
If you do not use all of your first dollar amount during the current calendar year, any unused portion may be carried over for use in the next calendar year.
- Carryover credit amounts can accumulate each year that you remain insured under this plan.
- Carryover credit may be used only for those services listed as "first dollar 100% services."
- This carryover credit benefit is available to you only while you are covered under an Active Choice plan through Blue Shield Life & Health Insurance Company.