30 In these cases, you may be able to continue seeing that Provider until treatment is complete, or for 90 days, whichever is shorter. If you wish to continue seeing the same Provider, you or your Doctor should contact Member Services for details. Any decision by us regarding a request for Continuity of Care is subject to the Grievance and External Review Procedures process. Your Cost-Shares Your Plan may involve Copayments, Deductibles, and/or Coinsurance, which are charges that you must pay when receiving Covered Services. Your Plan may also have an Out-of-Pocket Limit, which limits the cost-shares you must pay. Please read the “Schedule of Benefits” for details on your cost-shares. Also read the “Definitions” section for a better understanding of each type of cost share. Crediting Prior Plan Coverage If you were covered by the Employer’s prior carrier / plan immediately before the Employer signs up with the Plan, with no break in coverage, then you will get credit for any accrued Deductible amounts under that other plan. This does not apply to people who were not covered by the prior carrier or plan on the day before the Employer’s coverage with the Plan began, or to people who join the Employer later. If your Employer moves from one of the plans to another, (for example, changes its coverage from HMO to PPO), and you were covered by the other product immediately before enrolling in this product with no break in coverage, then you may get credit for any accrued Deductible and Out-of-Pocket amounts, if applicable and approved by the Plan. Any maximums, when applicable, will be carried over and charged against the maximums under this Plan. If your Employer offers more than one of the Plan’s products, and you change from one product to another with no break in coverage, you will get credit for any accrued Deductible and, if applicable, Out- of-Pocket amounts and any maximums will be carried over and charged against maximums under this Plan. If your Employer offers coverage through other products or carriers in addition to the Plan’s, and you change products or carriers to enroll in this product with no break in coverage, you will get credit for any accrued Deductible, under this Plan. This Section Does Not Apply To You If: • Your Employer moves to this Plan at the beginning of a Benefit Period; • You change from one of the Plan’s individual policies to a group plan; • You change employers; or • You are a new Member who joins the Employer after the Employer's initial enrollment with the Plan. The BlueCard Program Like all Blue Cross & Blue Shield plans throughout the country, the Plan participates in a program called "BlueCard" which provides services to you when you are outside the Plan’s Service Area. For more details on this program, please see “Inter-Plan Arrangements” in the “Claims Payment” section. Identification Card The Plan will give an Identification Card to each Member enrolled in the Plan. When you get care, you must show your Identification Card. Only covered Members have the right to services or benefits under this Booklet. If anyone gets services or benefits to which they are not entitled to under the terms of this Booklet, he/she must pay for the actual cost of the services.
2025 Retiree Indemnity Plan Booklet Page 30 Page 32