| After you meet
your Plan deductible, Blue Shield Life pays 80% of the allowable amount (up to $5,000)
for covered services, except outpatient psychiatric care. Blue Shield Life pays 100%
of the allowable amount for covered services in excess of $5,000. Please
note that Blue Shield Life pays only 50% for outpatient psychiatric care. (See Covered
Expenses.) In addition to your plan deductible, you will have to pay an
emergency room co-payment of $50 per visit for treatments that are not related
to an injury. This co-payment does not apply to inpatient admissions. Deductibles
Waived for Accidents If you have an accident while your policy is in
force, we will waive your plan deductible and emergency room co-payment for covered
charges. Extended Hospital Benefits If you are confined in
the hospital on the last day of your policy term, your coverage will continue
until you are released from the hospital or until you reach your benefit maximum,
whichever comes first. Maximum Benefit You and each of your
enrolled family members are covered for a maximum benefit of $2 million during
the policy term. Additional Benefit Your plan also includes Blue Shield
Life's $50,000 Accidental Death and Dismemberment Insurance Benefit. (This is
only available to applicants over age 19.) |