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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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Benefit Summaries - Grandfathered

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BlueChoice Healthcare Plan (HMO)

HMO Benefit Summaries (effective 10/1/2010)  
To view specific details of each Plan, click on the English version, as appropriate. 
100% Plans:  

HMO Plan G6000SX 
HMO Plan G6001SX 
HMO Plan G6002SX 
HMO Plan G6003SX 
HMO Plan G6008SX 
HMO Plan G6009SX 
 
90% Plans:  

HMO Plan G6200SX 
 
80% Plans:  

HMO Plan G6500SX 
HMO Plan G6502SX 
 
70% Plans:  

HMO Plan G6800SX 
HMO Plan G6802SX 
HMO Plan G6803SX 
 
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