Benefits at a Glance

After you meet the deductible (your choice of $500 or $1,000), Short-Term Blue pays 80 percent of the next $10,000 (individual policy calendar-year coinsurance maximum) of covered services per person or $20,000 (family policy calendar-year coinsurance maximum) per family. You pay the remaining 20 percent.

Once you've met the calendar-year coinsurance maximum, Short-Term Blue pays 100 percent of covered charges up to the $1 million lifetime maximum per person.

IMPORTANT NOTE: If you go "out of network," your deductible, coinsurance and coinsurance maximums will double.

Covered Benefits

The following services are covered under Short-Term Blue:

  • Inpatient hospital services
  • Outpatient services
  • Physician services
  • Emergency room services
  • Diagnostic lab and X-ray
  • Children's preventive care and immunizations
  • Durable medical equipment: $5,000 policy maximum
  • Ambulance: $1,000 policy maximum
  • Home health/private duty nursing: $4,000 policy maximum
  • Skilled nursing facility: 30-day policy maximum
  • Chemotherapy