Medicare Advantage Plan | Blue Cross and Blue Shield of Alabama

Choose from Two 2019 Plan Options

	Dental Blue^® Enroll Now Self ^$21 per month Self Plus One ^$42 per month Family ^$75 per month	Dental Blue^® Select Enroll Now Self ^$32 per month Self Plus One ^$66 per month Family ^$129 per month
Calendar Year Deductible	$50 per member	$50 per member
Annual Maximum Benefits	$1,000 per member	$1,500 per member
Diagnostic and Preventive Services (No waiting period)	Covered at 100% subject to deductible	Covered at 100% subject to deductible
Basic Services*	Covered at 75% subject to deductible	Covered at 80% subject to deductible
Major Services**	Covered at 50% subject to deductible	Covered at 50% subject to deductible
Additional Major Services**	Not covered	Covered at 50% subject to deductible
Orthodontic Services**	Not covered	Covered at 40% subject to deductible