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    • Trek Health
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    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesOther/IndeterminateArkansas BCBS HSA PPO Coverage Update | OpenPayer
    Ask Trek AI about this page
    CurrentArkansas Blue Cross and Blue ShieldPolicy 17-239

    Blue~By~Design HSA Comprehensive Major Medical Preferred Provider Organization Group Benefit Certificate

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    This benefit certificate governs Blue~By~Design HSA comprehensive major medical preferred provider organization coverage for eligible members of a small-group high-deductible health plan. It describes covered benefits, deductibles, cost sharing, provider-network differences, drug benefits, riders, and plan administration.

    Policy Summary
    PayerArkansas Blue Cross and Blue Shield
    PolicyBlue~By~Design HSA Comprehensive Major Medical PPO Group Benefit Certificate
    Policy CodePolicy 17-239
    Change TypeNo material clinical or coverage changes
    Effective DateJanuary 1, 2026
    Next Review DateN/A
    Key ActionNotify Arkansas Blue Cross and Blue Shield at 1-800-238-8379 if you are admitted to a hospital while outside Arkansas.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    UnlimitedLifetime benefit maximum
    $4,000 in / $8,000 outIndividual deductible
    0% in / 20% outCoinsurance
    No maximum

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Out-of-network coinsurance maximum
    YesStep-therapy drug formulary
    PPOPlan type

    Benefits and Specific Limitations in Your Plan

    Benefits and Specific Limitations in Your Plan

    The plan's benefits and specific limitations are organized into sections 3.1 through 3.9.

    Benefit provisions

    • Professional Services
    • Hospital Services
    • Ambulatory Surgery Center
    • Outpatient Diagnostic Services
    • Advanced Diagnostic Imaging Services
    • Maternity
    • Complications of Pregnancy
    • Therapy Services
    • Psychiatric Conditions and Substance Abuse Services

    Benefits and Specific Limitations in Your Plan

    The plan's benefits and specific limitations are organized into the following service categories.

    Benefits and specific limitations

    • Professional Services
    • Hospital Services
    • Ambulatory Surgery Center
    • Outpatient Diagnostic Services
    • Advanced Diagnostic Imaging Services
    • Maternity

    Section 3 medical service categories

    The table of contents identifies the following Section 3 medical benefit service categories.

    Section 3 medical benefit services

    • Professional Services

      Section 3.1; page 19

    • Hospital Services

      Section 3.2; page 20

    • Ambulatory Surgery Center

      Section 3.3; page 20

    • Outpatient Diagnostic Services

      Section 3.4; page 21

    • Advanced Diagnostic Imaging Services

    Important Notifications and Drug Benefit Rules

    Note

    Hospital Admission Outside Arkansas

    If you reside or are traveling outside the state of Arkansas and are admitted to a hospital, notify Arkansas Blue Cross and Blue Shield of your admission.

    • Call 1-800-238-8379 to provide notification.
    Note

    Pregnancy Support Notification

    As soon as you become aware of your pregnancy, call Special Delivery for pregnancy-support resources and notification guidance.

    • Call 1-800-225-1891, extension 20225.
    • Receive free educational materials and coupons by mail that encourage healthy practices during pregnancy.
    Step Therapy

    Standard Step-Therapy Drug Formulary

    Policy Summary
    PayerArkansas Blue Cross and Blue Shield
    PolicyBlue~By~Design HSA Comprehensive Major Medical PPO Group Benefit Certificate
    Policy CodePolicy 17-239
    Change TypeNo material clinical or coverage changes
    Effective DateJanuary 1, 2026
    Next Review DateN/A
    Key ActionNotify Arkansas Blue Cross and Blue Shield at 1-800-238-8379 if you are admitted to a hospital while outside Arkansas.
    SourceLink
    On This Page
    Benefits and Specific Limitations in Your PlanImportant Notifications and Drug Benefit Rules
    Complications of Pregnancy
  1. Therapy Services
  2. Psychiatric Conditions and Substance Abuse Services
  3. Emergency Care Services
  4. Durable Medical Equipment
  5. Section 3.5; page 21

  6. Maternity

    Section 3.6; page 21

  7. Complications of Pregnancy

    Section 3.7; page 23

  8. Therapy Services

    Section 3.8; page 23

  9. Psychiatric Conditions and Substance Abuse Services

    Section 3.9; page 23

  10. Emergency Care Services

    Section 3.10; page 24

  11. Durable Medical Equipment

    Section 3.11; page 24

  12. Medical Supplies

    Section 3.12; page 25

  13. Prosthetic and Orthotic Devices and Services

    Section 3.13; page 25

  14. Diabetes Management Services

    Section 3.14; page 25

  15. The standard step-therapy formulary applies to the retail drug benefit. Present the member ID card at the pharmacy for prescription processing; the drug benefit may also be subject to major medical benefits.