The State Health Plan Advantage provides this MAJOR MEDICAL benefit as an extension and addition to your BASIC benefit coverages.

A benefit period is based on the calendar year, January 1 through December 31.

During each benefit year, you are required to pay a maximum deductible of $300 per member or $600 per family in medical expenses before benefits are payable for covered MAJOR MEDICAL services.

Only the BCBSM approved amount for covered services can be credited toward your deductible requirement. Amounts you pay for services that are not covered do not apply to your deductible requirement.

Once you have met your deductible, the MAJOR MEDICAL benefit will generally pay a benefit equal to 90 percent of the BCBSM approved amount. You are then responsible for paying the remaining 10 percent. This is called your copayment. Once your individual copayments reach $1,000 per individual, except for any copayments made for outpatient mental/nervous conditions, no further copayments are required of you for the balance of that year. The amount applied toward your deductible requirement is not counted toward this copayment limit.

If you incur no medical expenses until October of any calendar year, expenses you incur during the last three months of that year will be applied against your MAJOR MEDICAL deductible requirement for the next calendar year.