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Blue Dimensions No Office Visit Copay with Full Card

To locate your specific Summary of Benefits and Coverage, identify your Deductible, Coinsurance, and Out of Pocket amounts for your plan.

BD = Blue Dimensions
NOVC = No Office Visit Copay
Ded = Deductible
Coin = Coinsurance
OOP = Out of Pocket
FC = Full Card for Pharmacy

 2012 Summary of Benefits and Coverage

$1000 Deductible
$10000 Deductible
$1250 Deductible
$1500 Deductible
$1750 Deductible
$2000 Deductible
$250 Deductible
$3000 Deductible
$500 Deductible
$5000 Deductible
$750 Deductible
$7500 Deductible

 2013 Summary of Benefits and Coverage

$1000 Deductible
$10000 Deductible
$1500 Deductible
$2000 Deductible
$250 Deductible
$3000 Deductible
$500 Deductible
$5000 Deductible
 
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