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Note: For certain maintenance drugs obtained from a retail pharmacy, after three fills each calendar year, a 50% coinsurance applies.

Fitness Benefit - All members may take part of the fitness benefit. For each membership, up to a total of $200 each calendar year is reimbursed for fees paid for a health club membership or for fitness classes at a health club. The member can claim this maximum fitness benefit for any combination of fees incurred by the subscriber and/or other members enrolled under the same family membership. However, each member claiming all or part of the fitness benefit must have paid at least four months health club fees for that calendar year.

This health plan covers routine hearing care services and supplies furnished by a Physician, Audiologist or Hearing Aid Dealer. These benefits are provided once for each member every 36 months and include:

Routine hearing exams once every 12 months.

Note: For covered transplants, benefits are also provided for transportation, lodging and meal costs for up to $100 each day, but no more than a $10,000 lifetime maximum for each eligible person.

Note: For covered transplants, benefits are also provided for transportation, lodging and meal costs for up to $100 each day, but no more than a $10,000 lifetime maximum for each eligible person.

Note: The copayment is waived for the brand-name drug Chantix.

One routine mammogram from age 35 through age 40 and one mammogram in each calendar year for a member age 41 or older.

Fitness Benefit - A member may take part of the fitness benefit. This health plan will reimburse up to a total of $300 each calendar year for fees paid for a health club membership or for fitness classes at a health club. (The member claiming all or part of the fitness benefit must have paid at least four months health club fees for that calendar year.)

Weight Loss Program Benefit - A member may take part of the weight loss program benefit. This health plan will reimburse up to a total of $300 each calendar year for fees paid for hospital-based weight loss programs or for non-hospital-based weight loss programs that are designated by Blue Cross Blue Shield.