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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 Option (POS)

POS Benefit Summaries (effective 10/1/2010)
To view specific details of each Plan, click on the English version, as appropriate. 
100/60% Plans: 

POS Plan G5001SX 
POS Plan G5002SX 
POS Plan G5003SX 
POS Plan G5004SX 
POS Plan G5010SX 
 
90/60% Plans: 

POS Plan G5200SX 
POS Plan G5201SX 
 
80/60% Plans: 

POS Plan G5500SX 
POS Plan G5501SX 
POS Plan G5502SX 
POS Plan G5503SX 
POS Plan G5504SX 
 
70/60% Plans: 

POS Plan G5800SX 
POS Plan G5801SX 
POS Plan G5804SX 
POS Plan G5805SX 
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