Page 22 - 2023-small-group-brochure

2
21
1
Site of service gives members choice
Site of service benefits1 give members choices when accessing certain services. Members save money on out-of-pocket costs based on where health care is received for the following services:
• Virtual care visits with network primary care doctors and specialists2
• Outpatient labs
• Outpatient surgery3
• Preventive colonoscopy4
• Physical/occupational therapy
• Routine/complex radiology
• Biotech/specialty injectables and infusion
1 Site of service benefits vary by plan design. Refer to the health plan charts beginning on page 37 for more details.
2 The site of service virtual care benefit is for in-network primary care and specialist visits and applies to most health plans. Refer to the health plan charts beginning on page 37
for more information.
3 Common outpatient surgical procedures performed at ambulatory surgical centers (ASCs) include tonsil removal, hernia repairs, and cataract surgeries.
4 Members pay $750 out of pocket by choosing non-Preventive Plus providers and professionals. Age and frequency guidelines apply to preventive care, such as colonoscopies.
The Preventive Plus benefit does not apply to members who reside or travel outside our service area and access care through the BlueCard® Program or the Away From Home Care® Guest Membership Program. For these members, a preventive colonoscopy to screen for colorectal cancer will be covered at no cost when they use an in-network provider. If they choose to visit an out-of-network provider, cost-sharing for their plan’s out-of-network benefit applies, and their out-of-pocket costs may be significantly higher. Diagnostic colonoscopies are subject to the cost-sharing provision of the member’s outpatient surgery benefit.