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    v1.0.31
    OpenPayerPolicy UpdatesOther/IndeterminateArkansas BCBS PPO Coverage Update | OpenPayer
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    CurrentArkansas Blue Cross and Blue ShieldPolicy 17-232

    Comprehensive Major Medical Preferred Provider Organization Group Benefit Certificate

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    This group benefit certificate governs comprehensive major medical preferred provider organization coverage for enrolled employees and dependents of a small group. It describes the schedule of benefits, cost sharing, prescription drug benefits, and optional benefit riders for the 2026 plan year.

    Policy Summary
    PayerArkansas Blue Cross and Blue Shield
    PolicyComprehensive Major Medical PPO Group Benefit Certificate
    Policy CodePolicy 17-232
    Change TypeNo material change
    Effective DateJanuary 1, 2026
    Next Review DateN/A
    Key ActionNotify the plan at 1-800-238-8379 if admitted to a hospital while outside Arkansas.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    $1,000Individual deductible
    $2,000Individual coinsurance maximum
    $6,000Family coinsurance maximum
    $10 / $30 / $50Prescription copayments

    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.

    YESStep therapy
    2026Benefit period

    Coverage Criteria and Benefit Rider Selections

    Additional Benefit Riders

    The following optional benefit riders are shown as not selected in the Additional Benefit Riders schedule.

    Riders not selected

    • Primary Care Physician Optional Benefit Rider — NO
    • Primary Care Physician/Specialty Care Physician Optional Benefit Rider — NO
    • Psychiatric Conditions Optional Benefit Rider — NO
    • Substance Abuse Optional Benefit Rider — NO

    General PPO Coverage Provisions

    Coverage is governed by the member-specific Schedule of Benefits and the Benefit Certificate, including applicable network provisions and exclusions.

    General coverage provisions

    • The Schedule of Benefits identifies the applicable plan benefits, Calendar Year Coinsurance Maximum amount, group number, identification number, type of coverage, and effective date.

      Refer to the member's Schedule of Benefits for plan-specific terms.

    • Covered benefits received from a non-preferred provider are paid at a rate less than like covered benefits received from a preferred provider, except in certain circumstances.

      Apply the provider network and cost-sharing procedures.

    • Specific plan exclusions apply to covered services.

      See the applicable Specific Plan Exclusions.

    • Primary Coverage Criteria and their purpose and effect govern coverage determinations under the insurance plan.

    Optional Benefit Rider Selections

    The Additional Benefit Riders schedule indicates that no optional rider is selected for the listed categories across selections 1 through 4.

    Optional rider selections 1–4

    • Selection 1: Primary Care Physician Optional Benefit Rider — NO; Primary Care Physician/Specialty Care Physician Optional Benefit Rider — NO; Psychiatric Conditions Optional Benefit Rider — NO; Substance Abuse Optional Benefit Rider — NO; Supplemental Accident Optional Benefit Rider — NO.
    • Selection 2: Primary Care Physician Optional Benefit Rider — NO; Primary Care Physician/Specialty Care Physician Optional Benefit Rider — NO; Psychiatric Conditions Optional Benefit Rider — NO; Substance Abuse Optional Benefit Rider — NO; Supplemental Accident Optional Benefit Rider — NO.
    • Selection 3: Primary Care Physician Optional Benefit Rider — NO; Primary Care Physician/Specialty Care Physician Optional Benefit Rider — NO; Psychiatric Conditions Optional Benefit Rider — NO; Substance Abuse Optional Benefit Rider — NO; Supplemental Accident Optional Benefit Rider — NO.
    • Selection 4: Primary Care Physician Optional Benefit Rider — NO; Primary Care Physician/Specialty Care Physician Optional Benefit Rider — NO; Psychiatric Conditions Optional Benefit Rider — NO; Substance Abuse Optional Benefit Rider — NO; Supplemental Accident Optional Benefit Rider — NO.

    Notifications and Provider Reimbursement

    Note

    Notify the Plan of Out-of-State Hospital Admission

    If you reside or are traveling outside Arkansas and are admitted to a hospital, call 1-800-238-8379 to notify Arkansas Blue Cross and Blue Shield of your admission.

    Billing Rule

    Non-Preferred Providers Paid at a Lower Rate

    Except in certain circumstances, covered benefits received from a non-preferred provider are paid at a lower rate than like covered benefits received from a preferred provider. Refer to the Schedule of Benefits and provider network and cost-sharing procedures for applicable details.

    Policy Summary
    PayerArkansas Blue Cross and Blue Shield
    PolicyComprehensive Major Medical PPO Group Benefit Certificate
    Policy CodePolicy 17-232
    Change TypeNo material change
    Effective DateJanuary 1, 2026
    Next Review DateN/A
    Key ActionNotify the plan at 1-800-238-8379 if admitted to a hospital while outside Arkansas.
    SourceLink
    On This Page
    Coverage Criteria and Benefit Rider SelectionsNotifications and Provider Reimbursement