WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 1 Introduction This Subscriber Certificate explains your health care coverage and the terms of your enrollment in this Blue Cross Blue Shield HMO Blue Preferred Blue PPO health plan. It describes your responsibilities to receive health care coverage and Blue Cross Blue Shield HMO Blue’s responsibilities to you. This Subscriber Certificate also has a Schedule of Benefits for your specific plan option. This schedule describes the cost share amounts that you must pay for covered services (such as a deductible or a copayment). You should read all parts of this Subscriber Certificate and your Schedule of Benefits to become familiar with the key points. You should keep them handy so that you can refer to them. The words that are shown in italics have special meanings. These words are explained in Part 2 of this Subscriber Certificate. When you enroll for coverage in this Preferred Blue PPO health plan, you may enroll as a group member under a group contract. Or, you may enroll directly under an individual contract. The contract for coverage in this health plan is a prepaid (“insured”) preferred provider plan. Blue Cross Blue Shield HMO Blue certifies that you have the right to this health care coverage as long as: you are enrolled in this health plan when you receive covered services; the premium that is owed for your health plan has been paid to Blue Cross Blue Shield HMO Blue; and you follow all of the requirements to receive this health care coverage. Blue Cross Blue Shield HMO Blue is located at: 101 Huntington Avenue, Suite 1300, Boston, Massachusetts 02199-7611. Blue Cross Blue Shield HMO Blue and/or your group (when you are enrolled in this health plan as a group member) may change the health care coverage described in this Subscriber Certificate and your Schedule of Benefits. If this is the case, the change is described in a rider. Please keep any riders with your Subscriber Certificate and Schedule of Benefits so that you can refer to them. This health plan is a preferred provider health plan. This means that you determine the costs that you will pay each time you choose a health care provider to furnish covered services. You will receive the highest level of benefits when you use health care providers who participate in your PPO health care network. These are called your “in-network benefits.” If you choose to use covered health care providers who do not participate in your PPO health care network, you will usually receive a lower level of benefits. In this case, your out-of-pocket costs will be more. These are called your “out-of-network benefits.” Before using your health care coverage, you should make note of the limits and exclusions. These limits and exclusions are described in this Subscriber Certificate in Parts 3, 4, 5, 6, 7, and 8. The term “you” refers to any member who has the right to the coverage provided by this health plan—the subscriber or the enrolled spouse or any other enrolled dependent.