Select Blue Advantage Series III
General Benefits
| In-Network Benefits | Out-of-Network Benefits |
| Select Blue Advantage pays 85% and you pay 15% of covered expenses after you meet your deductible | Select Blue Advantage pays 75% and you pay 25% of covered expenses after you meet your deductible |
| $25 office visit copay includes same day lab and x-ray, up to annual max of $750 | Physician office visits subject to deductible and coinsurance |
| Network providers will precertify your medical care | You must precertify hospital admissions and certain services |
| No claim forms to file | You may have to submit claims for reimbursement |
