Teamsters Local 1932 Health & Welfare Trust Enrollment Changes – Qualifying Life Event(s) Dear Member: Visit the Trust website at https://teamsters1932.zenith-american.com to complete your enrollment updates/changes online and for access to additional plan information. For your convenience, attached are the following documents to assist you with enrollment changes due to qualifying life events: Premium Deduction Election Form Enrollment Form Online Enrollment Instructions Plan Comparison of Benefits Cost Comparison If you prefer to complete the enclosed enrollment form, please choose from the options below to submit your completed enrollment form: • Secure Upload: Upload your Enrollment Form and supporting documentation on the website at https://teamsters1932.zenith-american.com • E-mail: [email protected]• Fax: (909) 789-1311 • Mail: Teamsters Local 1932 Health & Welfare Trust P.O. Box 571 San Bernardino, CA 92402-0571 Should you have any questions or need assistance with your enrollment updates/changes, contact your dedicated Customer Service Department at (909) 494-2916 or (866) 484-1337. Customer Service is available Monday through Friday 8am to 5pm PDT.
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Teamsters Local 1932 Health & Welfare Trust Enrollment ... · INITIAL HERE SECTION 4: ELECT MEDICAL AND DENTAL COVERAGE (Continued) DELTA DENTAL OPT-OUT/WAIVER Delta DHMO* Delta PPO
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Teamsters Local 1932 Health & Welfare Trust Enrollment Changes – Qualifying Life Event(s)
Dear Member: Visit the Trust website at https://teamsters1932.zenith-american.com to complete your enrollment updates/changes online and for access to additional plan information. For your convenience, attached are the following documents to assist you with enrollment changes due to qualifying life events: Premium Deduction Election Form Enrollment Form Online Enrollment Instructions Plan Comparison of Benefits Cost Comparison
If you prefer to complete the enclosed enrollment form, please choose from the options below to submit your completed enrollment form:
• Secure Upload: Upload your Enrollment Form and supporting documentation on the website at https://teamsters1932.zenith-american.com
• E-mail: [email protected] • Fax: (909) 789-1311 • Mail: Teamsters Local 1932 Health & Welfare Trust
P.O. Box 571 San Bernardino, CA 92402-0571
Should you have any questions or need assistance with your enrollment updates/changes, contact your dedicated Customer Service Department at (909) 494-2916 or (866) 484-1337. Customer Service is available Monday through Friday 8am to 5pm PDT.
REV. 8/09/2016 1 of 2 (Premium Deduction Election)
Ensure the most current form is submitted. Refer to EMACS Forms/Procedures website.
PREMIUM DEDUCTION ELECTION Must print in Black or Blue ink ONLY
Employee ID Rcd No. Last Name, First Name
Department Department ID Telephone
REASON FOR ELECTION AGREEMENT Date Event Date Event
New Hire Moved in/out of the HMO area
Adoption/Guardianship* Needles Subsidy/Change in Subsidy Eligibility
Birth* Open Enrollment
Death* Reduction in Hours for Employee or Spouse/Domestic Partner*
Disabled Over-Age Dependent (Please provide required Disabled Dependent Certification form)
Return from Unpaid Leave of Absence
Divorce/Dissolution of Domestic Partnership*(Please provide required mailing address of ex-spouse/domestic partner)
Mailing Address:
City, State, Zip:
Unpaid Leave of Absence Taken by Employee or Spouse/Domestic Partner*
Gain/Loss Spouse’s/Domestic Partner’s EEEmployment or Other Group Coverage*
Other:
Marriage/Domestic Partnership*
*Documentation is required for evidence of qualifying event (i.e.; Birth Certificate, Certificate of Marriage/Domestic Partnership, CourtOrders, Final Divorce Decree, Benefit Confirmation Statement, COBRA Notice, Loss of Coverage Letter, and Termination Notice)
BENEFIT ELECTIONS Check the appropriate tax elections and list all dependents you wish to enroll in benefits.
Plan Before Tax Name of Dependent
Tax Dependent
Yes No
Domestic Partner/Domestic Partner’s
ChildBefore Tax After Tax
Medical Dental
Voluntary Life AD&D Vision*
*Tax election for vision coverage applies only to Firefighters, Nurses, Probation, Specialized Peace Officer - Supervisory units
HR Use Only Comments
Enroll: Vision Life
DISTRIBUTION: Original - EBSD-HR (0440) Reviewed By(Employee ID)
Date Keyed By(Employee ID)
Date
Update AD&D from Employee + Spouse to Employee Only
AfterTax
REV. 8/09/2016 2 of 2 (Premium Deduction Election)
Authorization and Certification Employee signature is required for all qualifying events
I understand my share of the plan coverage cost may be adjusted to reflect any rate change. I acknowledge that my election is irrevocable unless there is a qualifying event in my family status and that in the absence of a family status change, my next opportunity to change this election will be during Open Enrollment. If I do not complete and return a new election form during Open Enrollment, the elections specified on page one of this Premium Deduction Election form will be maintained for the new plan year.
I hereby authorize the County of San Bernardino to obtain eligibility dates of coverage from previous Medical Plans for the exclusive purpose of determining my eligibility for the County of San Bernardino’s Premium Conversion Benefit Plan as required under Internal Revenue Code Section 125. I understand this authorization is only in effect for 60 days from the date of my signature.
Needles Subsidy Eligible Employees: I understand that my eligibility for the “Needles Subsidy” is entirely contingent upon being assigned to Needles, Trona, or Baker as my work location. I understand that it is my responsibility to notify the Employee Benefits and Services Division (EBSD) should my assigned work location change to an area other than Needles, Trona, or Baker. I further understand that should it be discovered that the Needles Subsidy has been paid to me in error, that the County will collect, through payroll deduction, any amount of subsidy for which I received and was not eligible.
________________________________ _____________________________________ Signature of Employee Print Employee Name
_______________________ Date
I understand my options in the Benefit Plan. I understand the County will reduce my salary in the amount of the plan coverage cost on either a before tax or after tax basis.
I understand that if at any time my or my family’s eligibility changes, I will notify EBSD or department payroll specialist within 60 days of the change in order to make the appropriate changes to my benefit deductions. For example, if I get divorced I am required to remove my ex-spouse from County sponsored Benefit Plans.
I understand that I will be taxed on the fair market value of any benefits for any individual who is not my Federal/State tax dependent.
Employee Signature Date
Payroll Specialist (Print & Sign) Telephone Date
Office Use Only
Approved Authorized Representative Signature Date
Denied
2020-2021 Enrollment Change Form – Life Event - Teamsters Local 1932 Health and Welfare Trust Page 1 of 4
ENROLLMENT CHANGE FORM – LIFE EVENT 2020-2021 PLAN YEAR TEAMSTERS LOCAL 1932 HEALTH AND WELFARE TRUST
Teamsters Trust Fund Administrative Office: 433 N. Sierra Way, San Bernardino, CA 92419-4831 P 909-494-2916 | P 866-484-1337 | Fax 909-789-1311
SECTION 1: EMPLOYEE INFORMATION
Employee ID Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
Home Address City State Zip Code Telephone
( )
Mailing Address □ Same as Home Address City State Zip Code Date of Hire
/ /
County of San Bernardino - Department Email Address
Qualifying Life Event
□ Add □ Change □ Remove
Eligibility requires proof of dependency, such a copy of the certified birth or marriage certificate or domestic partnership, adoption or placement paperwork, complete requirements are found in the Summary Plan Description located on the Trust’s website at https://Teamsters1932.zenith-american.com.
SECTION 2: ENROLLMENT DECISION - TEAMSTERS LOCAL 1932 HEALTH PLAN
□ As a dues paying member of Teamster’s Local 1932, I “Elect to Enroll” in the Teamsters Local 1932 Health and Welfare Trust. I previously opted out of coverage and my other coverage recently (within the last 60 days) terminated. Proof of the termination of coverage is enclosed with my Enrollment Form.
SECTION 3: ELECT MEDICAL AND DENTAL COVERAGE | SELECT ONE : ■ Pre-Tax or ■ Post-Tax
BLUE SHIELD HMO KAISER HMO BLUE SHIELD PPO OPT-OUT/WAIVER
□ HMO Platinum Plan $10 copay $0/admit; no charge Network: Access+
□ HMO Platinum Plan $10 copay $0/admit; no charge
□ PPO Non-Needles □ Medical Opt-Out/Waiver**
□ HMO Gold Access+ Plan $40 copay $100/admit; plus 20% $3,500 copay max Cal-yr Network: Access+
□ HMO Gold Plan $40 copay $100/admit; plus 20% $3,500 copay max Cal-yr
□ PPO Needles
□ HMO Gold Trio Plan $20 copay $100/admit; plus 20% $3,500 copay max Cal-yr Network: Trio
Mailing Address: P.O. Box 571 San Bernardino, CA 92402-0571
2020-2021 Enrollment Change Form – Life Event - Teamsters Local 1932 Health and Welfare Trust Page 2 of 4
INITIAL HERE
SECTION 4: ELECT MEDICAL AND DENTAL COVERAGE (Continued)
*Delta DHMO enrollees will continue with your current Delta-assigned Dentist if applicable, see Section 5. Alternately, a dentist located near your home will be assigned to you. Contact Delta Dental to change Dentists.
**Employees selecting to Opt-Out/Waiver of Medical and/or Dental Coverage are required to submit a completed & signed “Opt-Out/Waiver” Form; the Opt-Out/Waiver Form must be submitted, with all required documents as listed on
the Form, to the Trust Administrative Office for Review and Approval/Deny Decision.
SECTION 5: EMPLOYEE ENROLLMENT – CHANGE DUE TO QUALIFYING LIFE EVENT Paperwork must be received within 60 days of the qualifying life event. Elections made within 30 days will be processed retroactively.
Last Name, First Name, Middle Initial Marital Status
□ Single □ Married □ Domestic Partner
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
SECTION 6: DEPENDENT ENROLLMENT List all dependents to be covered; dependent verification documentation is required for all dependents. Provide the Social Security Number of each dependent you enroll. Federal regulations require health plans to report the names and Social Security Numbers of every covered individual to the IRS.
SPOUSE / DOMESTIC PARTNER:
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Spouse □ D.Ptnr
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
CHILD(REN) / STEPCHILD(REN):
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Child □ Stepchild
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
2020-2021 Enrollment Change Form – Life Event - Teamsters Local 1932 Health and Welfare Trust Page 3 of 4
INITIAL HERE
SECTION 6: DEPENDENT ENROLLMENT (Continued)
CHILD(REN) / STEPCHILD(REN):
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Child □ Stepchild
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Child □ Stepchild
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Child □ Stepchild
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Child □ Stepchild
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
Enroll in all products selected by Employee: □ Yes □ No (if no, describe coverage selection)
Relationship
□ Child □ Stepchild
Last Name, First Name, Middle Initial □ Male
□ Female
Date of Birth
/ / Social Security Number
BLUE SHIELD HMO ENROLLEES ONLY
Med. Group Name Physician Name Physician PCP ID# Existing Patient?
□ Yes □ No
DELTA DHMO ENROLLEES ONLY
Dentist Name Facility # Existing Patient?
□ Yes □ No
If you have more dependents to enroll, print out additional copy(ies) of page 3 and attach to your form.
2020-2021 Enrollment Change Form – Life Event - Teamsters Local 1932 Health and Welfare Trust Page 4 of 4
INITIAL HERE
SECTION 7: NEEDLES PLAN ENROLLMENT - COUNTY OF SAN BERNARDINO, NEEDLES SUBSIDY ELIGIBLE
I understand that Needles Plan Enrollment Eligibility and the County of San Bernardino "Needles Subsidy" are entirely contingent on my work-assignment to Needles, Trona, or Baker as my work location. I understand that it is my responsibility to notify both the Trust Administrator and the County Human Resources Department - Employee Benefits and Services Division (HR-EBSD) should my assigned work-location change to an area other than Needles, Trona, or Baker. I further understand that should it be discovered that the Needles Subsidy has been paid to me in error, the Employer (County of San Bernardino) may collect, through payroll deduction, any amount of subsidy for which I received and was not eligible.
SECTION 8: ARBITRATION AGREEMENT
I understand that (except for Small Claims Court cases, claims subject to a Medicare appeals procedure or the ERISA claims procedure regulation, and any other claims that cannot be subject to binding arbitration under governing law) any dispute between myself, my heirs, relatives, or other associated parties on the one hand and the Health Plan and Dental Plan selected above, any contracted health care providers, administrators, or other associated parties on the other hand, for alleged violation of any duty arising out of or related to membership in the Plan, including any claim for medical or hospital malpractice (a claim that medical services were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered), for premises liability, or relating to the coverage for, or delivery of, services or items, irrespective of legal theory, must be decided by binding arbitration under California law and not by lawsuit or resort to court process, except as applicable law provides for judicial review of arbitration proceedings. I agree to give up our right to a jury trial and accept the use of binding arbitration. I understand that the full arbitration provision is contained in the Evidence of Coverage.
Your signature indicates that you have completed all requested information as accurately as possible and understand all agreements implied including your agreement to submit disputes to binding arbitration. I have read and made the appropriate corrections and changes to the information on file with the Teamsters Local 1932 Health and Welfare Trust Administrative Office.
Employee Signature Date
/ /
INSTRUCTIONS SCREEN
1. The website is secure – The first time you log
on, you must register for an Account.
2. You will register by calling Customer Service
at 909-494-2916 or toll-free, 1-866-484-1337,
to set up your account; they will help you
enroll, or assist you with registering so that
you can enroll yourself at a later time.
3. Once you have activated your account, you
can enroll through the Teamsters Local 1932
Health & Welfare Trust online enrollment
module at https://Teamsters1932.zenith-
american.com; or Customer Service can
help walk you through enrollment.
YOUR ACCOUNT IS ACTIVATED YOU ARE READY TO ENROLL
1. Once you have activated your account, and
you choose to self-enroll; visit
https://Teamsters1932.zenith-american.com;
2. Key in your user name and password and
click on the button, Log into Your Account.
3. The first time (only) you log into your
account; you will see the Terms of Use
language.
a. To continue with the enrollment process, check the box to agree with the terms and use, and click continue.
a. Enter your dependents information, as requested in the fields displayed.
i. If the dependent you are adding has a different address than you, scroll down using the gray bar on the right side of the text box and key in their address.
b. Click the Save button
c. The new dependent will now display on your dependent screen. Click the Enroll button.
d. You can continue to add dependents. Once completed, click Continue.
YOUR ACCOUNT IS ACTIVATED YOU ARE READY TO ENROLL
7. Medical Plan Selection – When selecting the
Medical Plan option of your choice, you
must select Before Tax (BTX) or After Tax
(ATX). When selecting Before Tax or After Tax
for your medical plan, the same choice must
be made for your dental plan.
a. Blue Shield HMO Gold Trio ($20 co-payment) – New Option
b. Blue Shield HMO Platinum POS ($10 co-payment)
c. Blue Shield HMO Gold Access+ ($40 co-payment)
d. Blue Shield PPO (Non-Needles)
e. Blue Shield PPO Needles
f. Kaiser Gold Choice
g. Kaiser Platinum Plus
8. Select the medical plan option that best suits
you and your family’s needs and click the
button, Choose This Plan.
a. Once selecting your plan, you will need to click on the box next to each family member to be enrolled under your plan.
b. If you are selecting a Blue Shield HMO or POS Plan, you will need to enter the Primary Care Provider (PCP) Identification Number, or click on the option for Blue Shield to pick a PCP for you and/or your dependents.
c. If you request Blue Shield to select a PCP for you, one will be chosen in your geographical area.
d. Scroll to the bottom of the page and click Continue.
YOUR ACCOUNT IS ACTIVATED YOU ARE READY TO ENROLL
9. If you want to Waive/Opt Out of medical
coverage, scroll to the bottom of the page
and click on the Waive/Opt Out button.
a. You will be required to provide the Fund’s Administrative office proof of other coverage at the time the waive or opt-out is elected
b. You can submit the documentation via one of the below methods:
a. Employee only coverage is paid for by the County. Click Continue.
12. Review your enrollment information.
a. Review the Plan selections for you and each of your family members.
b. Review your bi-weekly benefits cost, based upon your Plan selections.
c. If there are no changes, click the Authorize box at the bottom of the screen verifying you have reviewed all information.
d. An Authorization box will display; scroll down using the gray bar on the right side of the text box. Click the Accept button.
e. Click the Submit button.
f. You will receive a message noting that your enrollment is complete. The message will include a reference number.
13. There is a dashboard on the left side of the
screen that will appear each time you log
into your account.
YOUR ACCOUNT IS ACTIVATED YOU ARE READY TO ENROLL
14. You can upload supporting documents, such
as marriage certificates or birth certificates
when adding new dependents, and have
them attached to your electronic file.
a. There are Customer Service Representatives to assist you in completing your enrollment form, and answer any questions you may have. Contact us at 909-494-2916 or (866) 484-1337 Monday through Friday from 8:00 a.m. – 5:00 p.m. PDT.
b. Other benefits are available to you through your employer. Make sure you also review your other benefit enrollment opportunities on the Employee Benefits section of the County’s portal.
BLUE SHIELD
HMO PLATINUM POS PLAN
($10-$30 COPAY)
BLUE SHIELD
HMO GOLD ACCESS+
PLAN
($40 COPAY)
BLUE SHIELD
HMO GOLD TRIO PLAN
($20 COPAY)
BLUE SHIELD
PPO NON-NEEDLES PLAN
KAISER
HMO PLATINUM PLAN
($10 COPAY)
KAISER
HMO GOLD PLAN
($40 COPAY)
LEVEL I - HMO LEVEL II - PPO ACCESS+HMO TRIO HMO PARTICIPATING PROVIDER NON-PARTICIPATING
Most specialty items - $15 copay (up to a 30-day supply)
Mail order (up to a
100-day supply):
Generic – $10 copay
Brand – $15 copay
Pharmacy (up to a 30-day supply): Generic – $15 copay Brand – $35 copay Most specialty items: 30%, not to exceed $200 (up to a 30-day supply)
Mail order (up to 100-day supply): Generic – $30 copay Brand – $70 copay
Pharmacy (retail and
mail order) copays
do not apply toward
the out-of- pocket
maximum.
Pharmacy (retail and mail
order) copays do not apply
toward the out-of- pocket
maximum
Pharmacy (retail and mail order) copays do not apply toward the out-of- pocket maximum
Other Services
Allergy testing
$10 copay
Allergy Serum: No
charge
$30 copay
Allergy Serum: No
charge
$40 copay
Allergy Serum: You
pay 40% copay
$20 copay
Allergy Serum: You pay
40% copay
You pay 20% (deductible does not apply)
Allergy Serum: 20% after CY deductible
You pay 30% after CY
deductible
Allergy serum: $10
copay Allergy serum: $5 copay
Chiropractic care Not covered Discount
program available
Not covered
Discount program
available
Not covered
Discount program
available
Not covered
Discount program
available
20% after CY deductible up
to 30 visits per calendar year
combined PPO/Non-PPO
maximum
30% after CY
deductible up to 30
visits per calendar
year combined
PPO/Non-PPO
maximum
Not covered
Not covered
Durable medical
equipment (DME)
Breast Pump
Orthotic
Equipment/devices
Prosthetic Equipment
No charge Not covered
DME: You pay 40%
No charge
No charge
No charge
DME: You pay 40%
No charge
No charge
No charge
You pay 20% after CY
deductible
Breast Pump: No charge
You pay 30% after CY
deductible
Breast Pump: Not
covered
No charge You pay 50%
Physical and Occupational Therapy
Office Location: $10
copay
Outpatient Dept. of a
Hospital: No charge
Office Location: $30 copay (up to 12 visits per calendar year
Outpatient Dept. of
$40 copay $20 copay You pay 20% (deductible
does not apply)
You pay 30% after CY
deductible $10 copay $40 copay
a Hospital: Not
covered
Speech Therapy
Office Location: $10
copay
Outpatient Dept. of a
Hospital: No charge
Office Location: $30 copay
Outpatient Dept. of a Hospital: Not covered
$40 copay $20 copay You pay 20% (deductible
does not apply)
You pay 30% after CY
deductible $10 copay $40 copay
Vision (exam only)
$10 copay
(one exam in a
consecutive 12-
month period
provided through
contracted VPA)
$0 up to $60/year
plus 100% of
additional charges
(one exam in a
consecutive 12-
month period
provided through
contracted VPA)
(Not covered) (Not covered)
You pay 20% self-referred
exam per 12 consecutive
months, no age limit (Vision
plan administrator’s providers
only)
You pay 20% self-
referred exam per 12
consecutive months,
no age limit (Vision
plan administrator’s
providers only)
No charge No charge
Travel
Network
(For urgent care
services)
Inside of US: Blue Card Program Outside of US: Blue Shield Global Core Program
Refer to your EOC
Inside of US: Blue Card Program Outside of US: Blue Shield Global Core Program
Refer to your EOC
Inside of US: Blue Card Program Outside of US: Blue Shield Global Core Program
Refer to your EOC
Inside of US: Blue Card Program Outside of US: Blue Shield Global Core Program
Refer to your EOC
Inside of US: Blue Card Program Outside of US: Blue Shield Global Core Program
Refer to your EOC
Inside of US: Blue Card Program Outside of US: Blue Shield Global Core Program
Refer to your EOC
Kaiser facilities in the US.
Claim forms required for Out of Area Urgent and ER care
Kaiser facilities in the US.
Claim forms required for Out of Area Urgent and ER care
Immunizations for purposes of Foreign Travel
$10 copay/injection $30 copay/injection $10 copay/injection $10 copay/injection You pay 20% after CY
deductible
You pay 30% after CY
deductible No charge No charge
Additional Travel
Information
provider.bcbs.com
bcbsglobalcore.com
provider.bcbs.com
bcbsglobalcore.com
provider.bcbs.com
bcbsglobalcore.com
provider.bcbs.com
bcbsglobalcore.com
provider.bcbs.com
bcbsglobalcore.com
provider.bcbs.com
bcbsglobalcore.com
kp.org (search for
“Travel Health”)
kp.org (search for “Travel
Health”)
Note! This is a Brief Comparison. Please refer to the Healthplan's Evidence of Coverage or Summary of Benefits for a detailed description of coverage, limitations and exclusions.