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Blue Dimensions Office Visit 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
OVC = Office Visit Copay
Ded = Deductible
Coin = Coinsurance
OOP = Out of Pocket
FC = Full Card for Pharmacy

 2012 Summary of Benefits and Coverage

$15 OVC
$25 OVC
$35 OVC

 2013 Summary of Benefits and Coverage

$15OVC $10000Ded
$15OVC $1000Ded
$15OVC $1500Ded
$15OVC $2000Ded
$15OVC $250Ded
$15OVC $3000Ded
$15OVC $5000Ded
$15OVC $500Ded
$25OVC $10000Ded
$25OVC $1000Ded
$25OVC $1500Ded
$25OVC $2000Ded
$25OVC $250Ded
$25OVC $3000Ded
$25OVC $5000Ded
$25OVC $500Ded
$35OVC $10000Ded
$35OVC $1000Ded
$35OVC $1500Ded
$35OVC $2000Ded
$35OVC $250Ded
$35OVC $3000Ded
$35OVC $5000Ded
$35OVC $500Ded
 
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