2022Health Care Coverage You Need.A Company You Know.Call 866-303-2583, visit or contact anindependent, authorized agent to get a quote today.

When It’s Time to Get Health Care Coverage,We’re Here for You.Choosing the right health care coverage to protect you and your family starts with a companyyou know. Blue Cross and Blue Shield of Oklahoma (BCBSOK) has been serving the people ofOklahoma since 1940. As a customer-owned health insurer, our focus is on our members, notshareholders. We work hard to make sure you have choices for your health care coverage.As health care in America changes, our dedication to our community will stay strong. BCBSOKwill be here serving the people of Oklahoma, just as we have for 80 years.Your BCBSOK plan includes thefollowing:C hoice of many doctors and hospitalsP rescription drug coverage, withmail-order program1Coverage for many preventive careservices2Mental health and substance usedisorder benefits and servicesC hoice of deductiblesHealth and wellness programsM ember account with tools to helpyou manage your coverage1 Learn more about prescription drug coverage on page 4.2 Many in-network preventive services are covered at 100%. Refer tothe Summary of Benefits and Coverage for benefit details.How can you sign up?Visit us online your independent, authorizedBlue Cross and Blue Shieldof Oklahoma agent.Call us toll-freeat 866-303-2583.

Signing Up for Health Care CoverageGetting your health care coverage from BCBSOK is animportant decision. Here are a few things to consider.When do you sign up?You can enroll or change plans duringthe Open Enrollment period, fromNovember 1, 2021 to January 15, 2022.What if you need to change outside that time period?If you have a major life event (got married or divorced, added toyour family, lost your group coverage, and so forth), you mayqualify for Special Enrollment. Visit tolearn more.Health care coverage may now bemore affordable than you think.3With the American Rescue Plan, financial help is now availableto even more people. This help is based on your family size andincome and can help lower your monthly premium paymentswhen you buy a plan through the Health Insurance Marketplacein Oklahoma.3 I f you are Native American, the cost-sharing amounts and income levels may be different.Please call 866-303-2583 or contact a BCBSOK agent for details.What are EssentialHealth Benefits?Our health care planscover basic services thatare considered essential togood health when you use anetwork doctor or hospital.These include: Ambulatory patient services Emergency servicesDID YOU KNOW?You may now qualify for lower payments.MORE PEOPLEcan now getfinancial help.YOUR BILLfor a health planmay go down. Hospitalization Maternity and newborn care Mental health and substance usedisorder services, includingbehavioral health treatment Prescription drugs Rehabilitative and habilitativeservices and devices Laboratory services Preventive services and chronicdisease management Pediatric services, including oraland vision care2

Blue Preferred PPOSM and Blue Advantage PPOSMBCBSOK offers two PPO options with access to different provider networks — Blue Preferred PPOand Blue Advantage PPO. Here’s an overview of how these BCBSOK plans work.Blue Preferred PPOBlue Advantage PPO May have higher monthly premiums May have lower monthly premiums A choice of doctors and hospitals throughoutthe state A choice of doctors and hospitals throughoutthe state PremiumChoice of DoctorsPremiumChoice of DoctorsNetworks vary and may not include every doctor or hospital in your area, so it is important to research your plan’snetwork before you buy. Please visit or call 866-303-2583 for more information.Health Plans to Fit Every BudgetWe have three levels of health care plans available — bronze, silver and gold. Each plan hasdifferent benefits and costs, so be sure to choose the one that fits your needs best. All plansinclude the same essential health SLowest premium costsHigher premium coststhan Bronze plansHigher premium coststhan Silver plansLower out-of-pocket coststhan Bronze plansLower out-of-pocket coststhan Silver plansHigher out-of-pocket costswhen you receive carePlan pays60%You pay40%Plan pays70%You pay30%Plan pays80%You pay20%The percentages shown reflect the average total cost for members, including all deductibles, copays and coinsurance. Your actual costs and ratios may vary based on your specific planand how you use your benefits. Please refer to the Summary of Benefits and Coverage for more information.3

Our Security and Dental Plan OptionsBlue Preferred Security PPOSMBlueCare DentalSMThis is a special catastrophic health careplan for certain people under age 30 andsome people with low incomes. This planhas lower premiums than other healthplans, but has higher deductibles. Get moreinformation by calling 866-303-2583 orcontacting a BCBSOK agent.BCBSOK has options to provide you andyour family with dental coverage. Ourdental plans provide coverage for cleanings,preventive services and much more. Learnmore at or contact aBCBSOK agent.Prescription Drug Coverage is Included in All Our PlansTierDrugTypeYourCost Your health plan’s prescription druglist has many levels of coverage,called payment level tiers.6Non-Preferred Specialty5Preferred SpecialtyOur plans have six payment leveltiers. Most often, the lower the tier,the lower your out-of-pocket costswill be for the drug.4Non-Preferred Brand3Preferred Brand2Non-Preferred Generic1Preferred Generic BCBSOK also offers ways for you to save time and money on your prescriptions.Learn more by visiting savings: You may pay less when you choose generic medicines from our drug list. You also may save when youget up to a 30-day supply of a covered prescription drug from an in-network pharmacy. Talk to your doctor about whatis right for you.Time savings: Maintenance medications are those drugs you take on a regular basis. You can have up to a 90-daysupply of these medications delivered directly to you through the mail order program or at a retail preferred pharmacyparticipating in the Preferred Pharmacy Network.4Online resources: You can search the drug list, find a pharmacy, see your claims, order home delivery, and getan estimate of your costs for a medication 24/7 by logging in to Blue Access for MembersSM (BAMSM) The Preferred Pharmacy Network does not apply to 100% cost-sharing plans.4

Get the Most From Your BCBSOK MembershipAt Blue Cross and Blue Shield of Oklahoma, we want you to be well. Our goal is to help you live ahealthier life. We work hard to provide our members with choices to help manage their health.Member ConnectionVirtual Visits powered by MDLIVE Get the BCBSOK App by textingBCBSOKAPP to 336335 or searchingfor BCBSOK in the Apple StoreSM orGoogle PlayTM Store. Register forBlue Access for Members6 righton your mobile device to: Get non-emergency care by phone, interactivevideo or mobile app from almost anywhere. See your claims coverage anddeductible information. Find an in-network doctor, hospital orurgent care facility. Access a temporary digital memberID card. Chat live with a Customer Servicerepresentative. Tell us how you want to get importanthealth and benefits information —by email, text or mail.Prefer desktop or PC?Register for Blue Access for Members instead. Available 24/7. Board-certified doctors can treat morethan 80 health conditions and even sende-prescriptions to your local pharmacy.Telemedicine Some primary care and other doctors mayoffer phone and online services which arecovered at the same member share as aregular office visit or in-person equivalent.Ask a Nurse Any Time 24/7 Nurseline is a service where nurseslisten to your health concerns, give youcommon health facts and tips, and help youknow where to go for care if you need it.Member Discount ProgramsFind Providers Use our online Provider Finder Our member discount program, Blue365 ,lets you save on useful health and wellnessproducts and services. Quickly find your nearest network doctor,hospital or clinic with this easy-to-useonline tool. Save on exercise equipment, gymmemberships, weight loss programs, stopsmoking programs and more. Search by specialty, read reviews andresearch providers. With many plans youcan also look up costs for some healthvisits and procedures.Health and Wellness Tools BCBSOK provides tools and resources likeWell onTarget to help guide you toward yourhealth and wellness goals. You can reach theportal at You can alsoaccess the portal through the AlwaysOn app.5 Message and data rates may apply. Terms and conditions and privacy policy at B CBSOK makes no representation or warranty with respect to the accuracy or completeness of information on BAM. The information on BAM is based on information provided by you and claimsreceived by BCBSOK. This information has not been independently verified.Virtual Visits may not be available on all plans. Non-emergency medical service in Montana and New Mexico is limited to interactive online video. Non-emergency medical service in Arkansas andIdaho is limited to interactive online video for initial consultation.MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Oklahoma. MDLIVE is solely responsible for its operations and for those of itscontracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. lue365 is a discount program only for BCBSOK members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. Please check your BenefitBBook or call the Customer Service number on the back of your ID card for specific benefit facts. Use of Blue365 does not change your monthly payment, nor do costs of the services or products counttoward any maximums and/or plan deductibles. Discounts are only given through vendors who take part in this program. BCBSOK does not guarantee or make any claims or recommendations aboutthe program’s services or products. You may want to talk to your doctor before using these services and products. BCBSOK reserves the right to stop or change this program at any time without notice.AlwaysOn is owned and operated by Onlife Health Inc. an independent company that has contracted with BCBSOK to provide digital health management for members with coverage through BCBSOK.The Well onTarget program is offered to you as a part of your benefits. Participation in the Well onTarget program, including the completion of a Health Assessment, is voluntary and you are notrequired to participate. Visit Well onTarget for complete details and terms and conditions.5T hird-party vendors do not offer Blue Products or Services. BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and servicesoffered by them.

Is a Health Savings Account (HSA) Right for You?7An HSA is a special savings account that you may use to cover a wide range of qualified medical expenses. An HSA helpsyou take charge of your health and be responsible for how you spend your health care dollars. For many people, usingan HSA is an effective way to help manage the costs of health care.Not all plans are HSA compatible. Visit or speak with a BCBSOK agent to learn more.Notice: If you get cost-sharing reductions under your health plan that have the effect of reducing the deductible below the federal government’s minimum deductible,you may not be eligible to contribute to a Health Savings Account.7 A s a reminder, a Health Savings Account (HSA) has tax and legal ramifications. Blue Cross and Blue Shield of Oklahoma does not provide legal or tax advice and nothing herein shouldbe construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on for the purpose ofavoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials.You should seek advice based on your particular circumstances from an independent tax adviser regarding the tax consequences of specific health insurance plans or products.Health Care Services That Work for YouTo help our members get care in their communities when they need it, we provide case management and utilizationmanagement services. We can help you find a new doctor when your child turns 18 and moves from the care of apediatrician to an adult level of care with a non-pediatrician primary care physician. We can also help members locatean OB-GYN for specialty care without referrals. You can find out about services that need prior authorization and howto get prior authorization at or by calling Customer Service at the number on the back of yourmember ID card.6

Depend on a company with 80 yearsof experience in Oklahoma.Enroll today.Visit us online your independent, authorizedBlue Cross and Blue Shieldof Oklahoma agent.Call us toll-freeat 866-303-2583.Privacy PracticesPlease visit the website at toview a copy of our policies and proceduresregarding collection, use and disclosure ofProtected Health Information (PHI).Notice About Your BenefitsTo get information about covered andnon-covered benefits, go to,contact your BCBSOK agent or call ourSales Center toll-free at 866-303-2583.This policy has exclusions, limitations andterms under which the policy may becontinued in force or discontinued. For costsand complete details of the coverage, callBCBSOK at 866-303-2583 or contact yourBCBSOK agent. Blue Cross and Blue Shield of Oklahoma is a Qualified Health Plan Issuer in the Health Insurance Marketplace in Oklahoma.Blue Cross , Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association,an association of independent Blue Cross and Blue Shield Plans.Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association600285.1021

Health care coverage is important for everyone.We provide free communication aids and services for anyone with a disability or who needs languageassistance. We do not discriminate on the basis of race, color, national origin, sex, gender identity, age,sexual orientation, health status or disability.To receive language or communication assistance free of charge, please call us at 855-710-6984.If you believe we have failed to provide a service, or think we have discriminated in another way, contact us to file a grievance.Office of Civil Rights CoordinatorPhone/TTY/TDD: Call the customer service number1400 S Boston Aveon your member ID cardTulsa, OK 74119Fax:800-279-7419You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at:U.S. Dept. of Health & Human ServicesPhone:800-368-1019200 Independence Ave SWTTY/TDD:800-537-7697Room 509F, HHH Building 1019Complaint Portal: ington, DC 20201Complaint Forms:

If you, or someone you are helping, have questions, you have the right to get help and informationin your language at no cost. To talk to an interpreter, call

Blue Preferred PPO May have lower monthly premiums A choice of doctors and hospitals throughout the state Blue Advantage PPO Networks vary and may not include every doctor or hospital in your area, so it is important to research your plan’s network before you buy. Please visit bcbso