About these Coverage Examples: The overall The overall $0 The overall $0 $0 $25 $25 $25 Hospital (facility) Hospital (facility) Hospital (facility) $250 $250 $250 Other Other Other $0 $0 $0 This EXAMPLE event includes services like: This EXAMPLE event includes services like: This EXAMPLE event includes services like: Specialist office visits (prenatal care) Primary care physician office visits (including Emergency room care (including medical supplies) Childbirth/Delivery Professional Services disease education) Diagnostic test (x-ray) Childbirth/Delivery Facility Services Diagnostic tests (blood work) Durable medical equipment (crutches) Diagnostic tests (ultrasounds and blood work) Prescription drugs Rehabilitation services (physical therapy) Specialist visit (anesthesia) Durable medical equipment (glucose meter) Total Example Cost Total Example Cost Example Cost $12,800 $7,400 $1,900 In this example, Peg pay: In this example, Joe would pay: In this example, Mia would pay:
About these Coverage Examples: The overall $0 The overall $0 The overall $0 $25 $25 $25 Hospital (facility) $250 Hospital (facility) $250 Hospital (facility) $250 Other $0 Other $0 Other $0 This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $12,800 Total Example Cost $7,400 Example Cost $1,900 In this example, Peg pay: In this example, Joe would pay: In this example, Mia would pay:
BMCS%20POS%20w-%20RX%202017%20SBC.docx