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| Eligibility | Individuals and family members enrolled in Flexible Blue II or Individual Care Blue Plus* |
| Monthly Rate | Starting at $7.61 (for Individual Care Blue Plus) Starting at $22.29 (for Flexible Blue II) |
| Copay: | Preventive services: 25 percent Basic restorative services: 50 percent |
| Deductible: | $0 |
| Annual Maximums: | $800 per member for all covered services, per calendar year |
| Waiting Period: | 90-day benefit waiting period on Class I and Class II services waived with proof of credible coverage. |