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EPP Portal > Product Setup Activity

Activity:
Confirm/Override Plan Details
Plan Name:
BCS1111
Product:
BlueChoice
Division:
IL
Effective Date:
00/00/0000
Version:
1
 


Confirm/Override Plan Details
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Plan Information

 
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Plan Information

Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes

Filter:

Deductible Embedded:

Yes No

In Coinsurance

In Emergency Room Copay

In Family OPX

In Family Stoploss Coinsurance

In Individual OPX

In Individual Stoploss Coinsurance

In Inpatient Hospital Copay

In Office PCP

In Office Specialist Copay

In Office Visit Copay

In Wellness Visit Copay

In 2nd Tier Individual OPX

In 2nd Tier Coinsurance

In 2nd Tier Emergency Room Copay

In 2nd Tier Family OPX

In 2nd Tier Family Stoploss Coinsurance

In 2nd Tier Individual Stoploss Coinsurance

In 2nd Tier Inpatient Hospital Copay

In 2nd Tier Office PCP

In 2nd Tier Office Specialist Copay

In 2nd Tier Office Visit Copay

In 2nd Tier Wellness Visit Copay

In 3rd Tier Coinsurance

In 3rd Tier Emergency Room Copay

In 3rd Tier Family OPX

In 3rd Tier Family Stoploss Coinsurance

In 3rd Tier Individual OPX

In 3rd Tier Individual Stoploss Coinsurance

In 3rd Tier Inpatient Hospital Copay

In 3rd Tier Office PCP

In 3rd Tier Office Specialist Copay

In 3rd Tier Office Visit Copay

In 3rd Tier Wellness Visit Copay

In/Out Combined Family Deductible

In/Out Combined Individual Deductible

Out 4th Tier Coinsurance

Out 4th Tier Emergency Room Copay

Out 4th Tier Family OPX

Out 4th Tier Family Stoploss Coinsurance

Out 4th Tier Individual OPX

Out 4th Individual Stoploss Coinsurance

Out 4th Tier Inpatient Hospital Copay

Out 4th Tier Office Specialist Copay

Out 4th Tier Office Visit Copay

Out 4th Tier Wellness Visit Copay

Outpatient Surgical Facility Copay

Rehabilitation Therapy (SP/PT/OT)

Upfront Deductible

Upfront Family Deductible

 
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Deductible Embedded:

Yes No

In Coinsurance

In Emergency Room Copay

In Family OPX

In Family Stoploss Coinsurance

In Individual OPX

In Individual Stoploss Coinsurance

In Inpatient Hospital Copay

In Office PCP

In Office Specialist Copay

In Office Visit Copay

In Wellness Visit Copay

In 2nd Tier Individual OPX

In 2nd Tier Coinsurance

In 2nd Tier Emergency Room Copay

In 2nd Tier Family OPX

In 2nd Tier Family Stoploss Coinsurance

In 2nd Tier Individual Stoploss Coinsurance

In 2nd Tier Inpatient Hospital Copay

In 2nd Tier Office PCP

In 2nd Tier Office Specialist Copay

In 2nd Tier Office Visit Copay

In 2nd Tier Wellness Visit Copay

In 3rd Tier Coinsurance

In 3rd Tier Emergency Room Copay

In 3rd Tier Family OPX

In 3rd Tier Family Stoploss Coinsurance

In 3rd Tier Individual OPX

In 3rd Tier Individual Stoploss Coinsurance

In 3rd Tier Inpatient Hospital Copay

In 3rd Tier Office PCP

In 3rd Tier Office Specialist Copay

In 3rd Tier Office Visit Copay

In 3rd Tier Wellness Visit Copay

In/Out Combined Family Deductible

In/Out Combined Individual Deductible

Out 4th Tier Coinsurance

Out 4th Tier Emergency Room Copay

Out 4th Tier Family OPX

Out 4th Tier Family Stoploss Coinsurance

Out 4th Tier Individual OPX

Out 4th Individual Stoploss Coinsurance

Out 4th Tier Inpatient Hospital Copay

Out 4th Tier Office Specialist Copay

Out 4th Tier Office Visit Copay

Out 4th Tier Wellness Visit Copay

Outpatient Surgical Facility Copay

Rehabilitation Therapy (SP/PT/OT)

Upfront Deductible

Upfront Family Deductible

Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Corporate Information

Yes No

 
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Corporate Information

Yes No

Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
{NRSG}Department

{NRSG}Scope Of Benefit

{SG}Department

{SG}Scope Of Benefit

 
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
{NRSG}Department

{NRSG}Scope Of Benefit

{SG}Department

{SG}Scope Of Benefit

Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Bluescript Drug

Yes No

Drug Card

Yes No

Drug Claim Submission Code

Retail Nonformulary

Mail Order Generic

Mail Order Nonformulary

Retail Generic

BlueScript Drugs

Drug Tier Structure Code

Drug Rider Code

Mail Order Formulary

Retail Formulary

Drug Copay Type Code

Drug ID Card Mailing Code

Drug Report Format Code

Drug Program Code

Drug Mail Order House Code

Drug Card Stock Code

4th Tier Drug

RX Percentage After Deductible

Drug Benefit Scope Code

 
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
Drug Claim Submission Code

Retail Nonformulary

Mail Order Generic

Mail Order Nonformulary

Retail Generic

BlueScript Drugs

Drug Tier Structure Code

Drug Rider Code

Mail Order Formulary

Retail Formulary

Drug Copay Type Code

Drug ID Card Mailing Code

Drug Report Format Code

Drug Program Code

Drug Mail Order House Code

Drug Card Stock Code

4th Tier Drug

RX Percentage After Deductible

Drug Benefit Scope Code

Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
BlueShield Under 65 Contract Code

Special Program

Funding Type

BlueCross Over 65 Contract Code

BlueCross Under 65 Contract Code

Drug Contract Code

BlueShield Over 65 Contract Code

Policy Type

ID Card

Alpha Prefix

Type Of Business

 
Plan Info  |  Benefits  |  Corporate Info  |  Market Segment  |  Pharmacy Codes  |  Product Codes
BlueShield Under 65 Contract Code

Special Program

Funding Type

BlueCross Over 65 Contract Code

BlueCross Under 65 Contract Code

Drug Contract Code

BlueShield Over 65 Contract Code

Policy Type

ID Card

Alpha Prefix

Type Of Business