SPECIAL PLAN FEATURES

The Blue Card PPO Network
When you use Blue Card PPO hospitals and doctors for your medical care, you save money because the rates charged by PPO providers are usually lower. In addition, the Plan will pay a higher percentage of your covered expenses when you use Blue Card hospitals and doctors. For more information see page 40.

Prescription Drug Program Through Express Scripts
Your Express Scripts I.D. card enables you to purchase covered prescription drugs at participating pharmacies for contracted prices that are usually lower than regular retail prices. The Mail Service Program allows you to buy covered long-term prescription drugs for $10/$20/$35 co-pays. These programs are explained in more detail on pages 53-55.

Hospital Certification Program
A $250 deductible will apply to the covered medical expenses incurred during each hospitalization where the Hospital Certification Program procedures are not followed. See page 40for more information.

Dental Network of America
The Dental Network of America (DNoA) offers a large network of participating dentists who have agreed to charge negotiated fees that are lower than what they normally charge. This is a voluntary program—you are not required to use a DNoA dentist, and your benefits won’t be reduced if you use a non-participating dentist. See page 63 for additional information.

ValueOptions Provider Network for Substance Abuse and Mental or Nervous Disorders
Your benefits for treatment of substance abuse and mental or nervous disorders will be paid under the higher In-Network Schedule if the facility or counselor providing the treatment is a member of the ValueOptions Provider Network. Additional information is on page 56.>
Mental Health Review Program
You or your doctor must call ValueOptions before any type of treatment for substance abuse and mental or nervous disorders begins, and the treatment must be precertified by ValueOptions as medically necessary under the terms of the Plan. If this requirement is not met, no benefits of any kind will be payable for the treatment. See page 56 for details.

Lineco Member Assistance Program (MAP)
ValueOptions has thousands of experienced, professional counselors to help you with any kind of personal problem. You can get up to 6 face-to-face visits per problem with a professional MAP counselor at no cost to you. More information is on pages 60-62.

Prenatal Care Program
If you participate in the Prenatal Care Program through Medical Cost Management (MCM) the Plan will pay up to $500 in benefits for routine well-child care for the child after birth and through age 4 (provided the child is eligible at the time such care is provided). These benefits will not be paid UNLESS the mother completes MCM’s prenatal care program. See page 50 for more information.

HearPO Network
HearPO offers a large network of participating hearing care providers who have agreed to provide hearing exams, tests and hearing aid devices at substantial discounts (average 30%). Refer to your HearPO brochure for more information. (You are not required to use a HearPO provider to receive hearing benefits.)