ƒ The out-of-pocket/copayment maximums include the plan deductible.

p The initial flat dollar emergency room copayment is waived if you are admitted directly to the hospital as an inpatient.

a Dental services provided through Dental Benefit Providers (DBP). Benefits limited to $500 per calendar year. Three month waiting period following the effective date of coverage for minor restorative services.

? Vision exam provided through MESVision network.

ß The plan is subject to regulatory approval.

With an HMO plan, members must live or work within the Blue Shield HMO service area and have a designated Personal Physician to enroll and maintain enrollment. The Blue Shield HMO service area is identified in the HMO Physician and Hospital Directory. Each eligible family member may select a different Personal Physician, as long as each provider is located adequately close to the member's home or work address to ensure access to care (as determined by Blue Shield).

This information is intended as a brief comparison of some of the benefits of the various Blue Shield plans and shows copay/coinsurance amounts you will pay for services received from preferred providers only. You should review the Combined Summary of Benefits or the Evidence of Coverage/Certificate of Insurance and Plan Contract/Policy for a more complete description of the benefits, terms and conditions and limitations of the health plans.

Note: The federal Health Insurance Portability and Accountability Act (HIPAA) makes it easier for people with pre-existing conditions who are covered under existing group health plans to maintain coverage of pre-existing conditions when they change jobs or are unemployed for brief periods of time. If you meet all the specified conditions, you may be eligible for a guaranteed issue plan in accordance with HIPAA. For more information, contact your agent