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Blue Choice
Blue Choice
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Blue Choice is Rochester's leader in quality. That means you get first-class coverage with the value you need. Click on the menu tabs below to view a summary of benefits for our family of Blue Choice plans.
For more information, contact your sales consultant or broker.
Blue Choice $25 Copay Option Benefit Summary
Referrals Referrals NOT required effective 1/1/2011
Inpatient Hospitalization $250 hospital copayment
$200 physician surgical copayment
Outpatient Surgery $50 hospital copayment
$40 physician copayment
Emergency Room Care for Emergency Medical Conditions $100 copayment
Office Visits $25 PCP copayment
$40 Specialist copayment
Sick Child Visits $25 copayment
Adult Physicals $25 copayment
Well Child Visits Covered in full
Preventive Dental for Children No coverage
Eye Exams $40 copayment, once every 2 years; every year for children up to age 19
Eyewear $60 allowance, once every 2 years; every year for children up to age 19
Prescription Drug Tier 1: $10 copayment
Tier 2: $30 copayment
Tier 3: $50 copayment
For each 30 day supply.
Includes oral contraceptives.
Out of Network Benefits Emergency services only
Acupuncture Discounts available through Member Rewards
Chiropractic $40 copayment

This summary is not a contract or binding agreement. It reflects many commonly held benefits for this plan. Benefits will be different for members of certain employer groups. For details about your specific coverage, ask your employer or contact Member Services by email or by calling the number on your member ID card.

To be covered, all services must be medically necessary for the diagnosis and treatment of your condition, covered by your insurance contract, approved by the Medical Director, and performed, prescribed or authorized in advance by your Primary Care Physician.

Blue Choice $30 Copay Option Benefit Summary
Referrals Referrals NOT required effective 1/1/2011
Inpatient Hospitalization $500 hospital copayment
$300 physician surgical copayment
Outpatient Surgery $150 hospital copayment
$50 physician copayment
Emergency Room Care for Emergency Medical Conditions $150 copayment
Office Visits $30 PCP copayment
$50 Specialist copayment
Sick Child Visits $30 copayment
Adult Physicals $30 copayment
Well Child Visits Covered in full
Preventive Dental for Children No coverage
Eye Exams $50 copayment, once every 2 years; every year for children up to age 19
Eyewear $60 allowance, once every 2 years; every year for children up to age 19
Prescription Drug Tier 1: $10 copayment
Tier 2: $30 copayment
Tier 3: $50 copayment
For each 30 day supply.
Includes oral contraceptives.
Out of Network Benefits Emergency services only
Chiropractic $50 copayment

This summary is not a contract or binding agreement. It reflects many commonly held benefits for this plan. Benefits will be different for members of certain employer groups. For details about your specific coverage, ask your employer or contact Member Services by email or by calling the number on your member ID card.

To be covered, all services must be medically necessary for the diagnosis and treatment of your condition, covered by your insurance contract, approved by the Medical Director, and performed, prescribed or authorized in advance by your Primary Care Physician.

Blue Choice Value Benefit Summary
Referrals Referrals NOT required effective 1/1/2011
Inpatient Hospitalization $100 hospital copayment
$100 physician surgical copayment
Outpatient Surgery $50 hospital copayment
$20 physician copayment
Emergency Room Care for Emergency Medical Conditions $50 copayment
Office Visits $20 PCP copayment
$20 Specialist copayment
Sick Child Visits $20 copayment
Adult Physicals $20 copayment
Well Child Visits Covered in full
Preventive Dental for Children No coverage
Eye Exams $20 copayment, once every 2 years; every year for children up to age 19
Eyewear $60 allowance, once every 2 years; every year for children up to age 19
Prescription Drug Tier 1: $10 copayment
Tier 2: $25 copayment
Tier 3: $40 copayment
For each 30 day supply.
Includes oral contraceptives.
Out of Network Benefits No Coverage
Acupuncture 10 visits @ 50%
Chiropractic $20 copayment

This summary is not a contract or binding agreement. It reflects many commonly held benefits for this plan. Benefits will be different for members of certain employer groups. For details about your specific coverage, ask your employer or contact Member Services by email or by calling the number on your member ID card.

To be covered, all services must be medically necessary for the diagnosis and treatment of your condition, covered by your insurance contract, approved by the Medical Director, and performed, prescribed or authorized in advance by your Primary Care Physician.

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