Availity Portal

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

View requirements for Local Plan and BlueCard Out-of-Area members.

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Benefit Summaries - Non-Grandfathered


BlueChoice PPO

PPO Benefit Summaries (effective 10/01/2010)  
To view specific details of each Plan, click on the English version, as appropriate.  
100/70% Plans:  

PPO Plan 1002SX 
PPO Plan 1003SX 
90/70% Plans:  

PPO Plan 1200SX 
90/60% Plans:  

PPO Plan 1201SX 
PPO Plan 1202SX 
PPO Plan 1203SX 
PPO Plan 1204SX 
80/60% Plans:  

PPO Plan 1500SX 
PPO Plan 1501SX 
PPO Plan 1502SX 
PPO Plan 1503SX 
PPO Plan 1504SX 
PPO Plan 1505SX 
PPO Plan 1506SX 
PPO Plan 1508SX 
PPO Plan 1510SX 
PPO Plan 1512SX 
PPO Plan 1513SX 
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