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Arizona Medical Insurance > BlueCross BlueShield of Arizona > BluePreferred® Saver Benefits

BCBSAZ

Quote & Apply - Electronic Application



BluePreferred Saver is a qualified high-deductible plan for use with a health savings account (HSA). All services are subject to your deductible, except preventive care. You must satisfy certain criteria to be eligible to open and/or contribute to an HSA. Check with your tax or legal advisor regarding whether you satisfy these criteria.

BluePreferred Saver - PPO PLAN Benefit Summary
 
PREFERRED PROVIDER (PPO)
IN-NETWORK
NONPREFERRED PROVIDER (NonPPO)
OUT-OF-NETWORK
Deductible (Calendar-year)
Preferred deductibles are accumulated separately from nonPreferred deductibles.  Deductible must be met for all covered services unless otherwise stated.		 $1,500 self-only*, $3,000 family*

*Unless otherwise stated, the self-only deductible must be met on single policies and the family deductible must be met on family policies before BCBSAZ will pay for covered services.

$2,600 per person, $5,150 family
$5,000 per person, $10,000 family		 $2,000 self-only*, $3,500 family*

*Unless otherwise stated, the self-only deductible must be met on single policies and the family deductible must be met on family policies before BCBSAZ will pay for covered services.

$3,100 per person, $5,650 family
$5,500 per person, $10,500 family
Coinsurance 1, 2 BCBSAZ pays 100%, you pay 0% of the BCBSAZ allowed amount for most covered services after meeting deductible, unless a different coinsurance percentage is indicated. On the $1,500 and $2,600 deductible options, some services (outpatient mental health, inpatient rehabilitation and skilled nursing) are covered at 50% coinsurance and continue to accumulate toward the outof- pocket maximum, even after the deductible is met. BCBSAZ pays 50%, you pay 50% (50%/50%) of the BCBSAZ allowed amount for most covered services, after meeting deductible, unless a different coinsurance percentage is indicated.
Out-of-Pocket Coinsurance Maximum 2 (Calendar-year)
The Preferred out-of-pocket maximum is accumulated separately from the nonPreferred out-of-pocket maximum.		 Per person
$5,000		 Family
$10,000		 Per person
$5,000
 Family
$10,000
You are still responsible for a noncontracted provider’s billed charges even after the out-of-pocket coinsurance maximum is met.
Physician Services – Office Visits3
 BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Preventive Care, Mammography, Routine Physical Exams BCBSAZ pays 100% Not covered except for routine mammograms.  Routine mammography: 50%/50%.
The deductible does not apply to covered preventive care services.
Laboratory Services BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Other Professional Services BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Covered services include diagnostic, surgical and anesthesia services rendered outside the physician’s office.
Prescription Medications at Retail and Mail Order Pharmacy3
Payment for mail order must be made with a debit or credit card and is only available through the Preferred mail order provider.		 30-day retail and 90-day mail order supply
BCBSAZ pays 100% after meeting deductible.		 50%/50% after meeting deductible. You are also responsible for the difference between a noncontracted pharmacy’s price and BCBSAZ’s allowed amount. Mail order is not covered through a noncontracted provider.
Inpatient Hospital 4 BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Outpatient Services
(Facility charges)		 BCBSAZ pays 100% after meeting deductible.. 50%/50% after meeting deductible.
Urgent Care BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Emergency or Accident $150 access fee (per person, per provider, per day), then BCBSAZ pays 100%, after meeting deductible; emergency room access fee is waived if you are admitted to the hospital.
Maternity – Complications of Pregnancy Only BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Physical, Occupational and Speech Therapy BCBSAZ pays 100% after meeting deductible.. 50%/50% after meeting deductible.
Chiropractic Services BCBSAZ pays 100% after meeting deductible. 50%/50% after meeting deductible.
Ambulance Services BCBSAZ pays 100% after meeting deductible.

Behavioral and Mental Health Services 4
Both Preferred and nonPreferred admissions count toward the 2-admissions, 30-day limit.

Outpatient: 50%/50% after meeting deductible, with a maximum of 20 psychological sessions per person, per calendar-year.
Inpatient facility: Two admissions per person, per calendar-year, up to a combined total of 30 days.
Preferred facility: BCBSAZ pays 100% after meeting deductible. NonPreferred facility: 50%/50% after meeting deductible.
Preferred and NonPreferred inpatient professional services: 50%/50% after meeting deductible. 
$25,000 per person benefit maximum for all services while the contract is in force.
Inpatient Rehabilitation Services 4
Both Preferred and nonPreferred admissions count toward the 120-day calendar-year limit.		 BCBSAZ pays 100% after meeting deductible, up to 60 days. After 60 days, 50%/50% up to an additional 60 days. 50%/50% after meeting deductible.
Limited to 120 days per calendar year.
Home Health Services and Home Infusion - Medication Administration Therapy 5 BCBSAZ pays 100% after meeting deductible. Certain injectable medications are also available through the specialty injectable medication benefit. 50%/50% after meeting deductible.
Skilled Nursing Facility 4
Both Preferred and nonPreferred admissions count toward the 180-day calendar-year limit.		 BCBSAZ pays 100% after meeting deductible, up to 90 days. After 90 days, 50%/50% up to an additional 90 days. 50%/50% after meeting deductible.
Limited to 180 days per calendar year.
Specialty Self-Injectable Medications through Specialty Pharmacy 4
For certain specified self-injectable
prescription biologic medications. Specialty injectable medications are not covered under the retail or mail order medication benefit. (Also see Home Health.)

Contracted specialty pharmacy (30-day supply)
BCBSAZ pays 100% after meeting deductible. 

Please refer to azblue.com for a listing of specialty self-injectable medications and contracted specialty pharmacies or call BCBSAZ.

 Not Covered (see Home Health).
Contract Maximum $3,000,000 maximum benefit per person while the contract is in force. All payments by BCBSAZ (for both Preferred
and nonPreferred providers) apply toward the contract maximum.
  1. Coinsurance is a percentage you must pay for covered services after you have met the calendar-year deductible. You will pay a higher coinsurance percentage when using a nonPreferred provider. Coinsurance is based on the BCBSAZ allowed amount.
  2. In addition to any applicable deductible and coinsurance, noncontracted providers may charge you for the difference between their billed charges and the BCBSAZ allowed amount. This obligation to pay the difference between the provider’s billed charges and the BCBSAZ allowed amount continues even after the member’s out-of-pocket maximum is met. Coinsurance, access fees and deductibles count toward the out-of-pocket maximum.
  3. Precertification is required for certain medications covered under the retail and mail order pharmacy benefit. A list of medications that require precertification and the process for obtaining precertification is available on the BCBSAZ Web site at azblue.com or by calling BCBSAZ at (602) 864-4273 or (800) 232-2345, ext. 4273. Otherwise covered eligible medications will not be covered if precertification is not obtained when required.
  4. Precertification is required. If precertification is not obtained, services will be subject to an additional $300 deductible or denial of benefits.
  5. Precertification is required for certain medications provided through the Home Health and Home Infusion - Medication Administration Therapy benefit. A list of medications requiring precertification is available on the BCBSAZ Web site at azblue.com or by calling BCBSAZ at (602) 864-4320 or (800) 232-2345, ext. 4320. Otherwise covered eligible medications will not be covered if precertification is not obtained when required.

 

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