24-HOUR NURSE ADVICE LINE Free advice from a registered nurse. Visit carefirst.com/frederick to learn more about your options for care. When your doctor is not available, call 800-535-9700 to speak with a registered nurse about your health questions and treatment options. ANNUAL DEDUCTIBLE (Benefit period)4 Individual None $200 Family None $400 ANNUAL OUT-OF-POCKET MAXIMUM (Benefit period)5 Medical None $1,250 Individual/$2,500 Family LIFETIME MAXIMUM BENEFIT Lifetime Maximum None None PREVENTIVE SERVICES Well-Child Care (including exams & immunizations) No charge* Deductible, then 20% of Allowed Benefit Adult Physical Examination (including routine GYN visit) No charge* Deductible, then 20% of Allowed Benefit Breast Cancer Screening No charge* Deductible, then 20% of Allowed Benefit Pap Test No charge* Deductible, then 20% of Allowed Benefit Prostate Cancer Screening No charge* Deductible, then 20% of Allowed Benefit Colorectal Cancer Screening No charge* Deductible, then 20% of Allowed Benefit OFFICE VISITS, LABS AND TESTING Office Visits for Illness $20 PCP/$35 Specialist per visit Deductible, then 20% of Allowed Benefit Imaging (MRA/MRS, MRI, PET & CAT scans)6 No charge* Deductible, then 20% of Allowed Benefit Lab6 No charge* Deductible, then 20% of Allowed Benefit
