* Out-of-pocket maximums for in-network and out-of-network covered services are separate and do not combine. 

Note: Lifetime maximum benefit - $5,000,000.  Any balance of charges (between billed charges and maximum allowable charge) does not apply toward your deductible or out-of-pocket maximum.

This information is presented only as a very brief overview of some of the benefits of this plan, and is intended only for general education.  The amount of benefits provided depends on the plan selected. Premium will vary with the type of benefits selected.  These plans contain exclusions from and limitations of coverage.  Please see the product brochure for more complete information, as well as information about terms of renew ability, preexisting conditions, out-of-network penalties, and notification requirements.  Plans are subject to health underwriting.  To be considered for reimbursement, expenses must qualify as covered expenses.  Expenses are also subject to reasonable and customary limits, unless you use a network, and all other policy provisions, including determinations of medical necessity.

Benefits paid at 100 percent when you use network providers:

• Routine wellness examinations for adults and children (subject to an office visit copay of $20)
  
• Immunizations
  
• Preventive and well care screenings

Benefits paid after you meet your deductible (subject to coinsurance, if applicable):

Prescription Drug Coverage - The prescription drug network includes over 1,800 pharmacies statewide including most national chains and select independent pharmacies.  You can also make use of their home delivery pharmacy services.

If you should ever want to consult a doctor or visit a hospital outside the network, you're still covered.  It simply means that the doctor or hospital will be allowed to bill you - and you will be financially responsible for - the difference between BlueCross BlueShield of Tennessee's in-network negotiated payment rate and the amount charged by the out-of-network doctor or hospital.  Plus, your out-of-pocket expenses for non-network providers are applied to a separate, higher out-of-pocket maximum.

Blue Network was built around medical centers in major metropolitan areas and members may be required to travel greater distances to receive in-network care.  For example, Blue Network members who live in rural areas of middle Tennessee may be required to travel to Nashville to receive in-network services.  Or, Blue Network may only include certain highly-specialized providers in one urban center, requiring a member to travel from Chattanooga to Nashville.  So make sure that you are comfortable with Blue Network's providers, as well as the distance you may have to travel to receive in-network care.

You can see if your doctor is a preferred provider by checking the Directory of Participating Providers.

Effective dates will not be moved forward without proof of other insurance coverage.  This information must be received during the 10-day free look period of the policy.

It is standard practice to request a Blood Pressure Inquiry on all applicants who are currently being treated for or who have recently discontinued treatment for high blood pressure.  Certain conditions may be waivered with a temporary rider (usually for one to two years), or an indefinite rider.

Please note, if you are requesting an effective date of less than 21 days from the time you complete the application, you may not receive notification of your approval until after your effective date.  If you have claims during this period, they will be eligible for coverage if submitted after you have been approved.  Also note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved.  This is very good for someone who does not have any present coverage and would like for their benefits to begin right away.  For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either HSA for America or directly from BlueCross BlueShield of Tennessee that your coverage has been approved and is in force.

Because of this affiliation, which includes more than 40 other member organizations, BlueCross BlueShield customers have access to the same network of doctors and hospitals while traveling or living out of state that they have while in Tennessee.

With more than 2 million members, BlueCross BlueShield of Tennessee is 11th in size when compared to other BlueCross plans. Compared to others financially, the company is one of the strongest in relation to its membership base.

From what we can see, BlueCross BlueShield of Tennessee is committed to remaining an independent, not-for-profit, locally governed health plan company.  This format allows the company to do a good job serving the needs of local businesses, families and individuals throughout Tennessee.

BlueCross BlueShield of Tennessee has been assigned an Standard and Poor's rating of A+ (Strong).

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.  ® Registered marks of the BlueCross BlueShield Association, an Association of Independent BlueCross BlueShield Plans.