Understanding your medical and prescription drug program is important to help you make more cost effective choices.
Get a routine physical exam and age-appropriate health screenings.
These services are covered at 100% when you receive preventive care through an in-network provider. Plus, seeing your doctor for an annual visit can help prevent a chronic condition or detect a disease early for an optimal outcome.
Know when to visit your doctor, urgent care center or emergency room.
If you or a family member needs sudden care, it’s important to understand when you should seek care at your doctor’s office, MDLive, urgent care center versus an emergency room visit.
Work with your doctor to determine the most effective, cost efficient prescription drug option.
If you or a family member need a prescription drug, a generic medication may be the best option – they are just as effective as their brand name counterparts and cost less.
PPO Plan 14 Details
| Deductible | In-network: Single: $1,250 Family: $2,500 |
| Coinsurance | In-network: You pay 20% Plan pays 80% |
| Out-of-Pocket Maximum | In-network: Individual: $3,750 Family: $7,500 |
| Preventive Care (typically annual physical) | In-network: $0 copay/visit |
| Primary Care Physician Office Visit | In-network: $35 copay/visit |
| Behavioral/Mental Health Office Visit | In-network: $35 copay/visit |
| Specialist Office Visit | In-network: $50 copay/visit |
| Virtual Care – Teladoc | Virtual care is available through Teladoc. Copays are typically $35 per visit, but may vary depending on the type of visit. |
| Emergency Room | In-network: You pay 20% (after deductible) Plan pays 80% (after deductible) |
| Urgent Care | In-network: $50 copay/visit |
| Outpatient and Inpatient Hospital | In-network: You pay 20% (after deductible) Plan pays 80% (after deductible) |
| Prescription Drug | In Network: Retail Tier 1: $10 copay Tier 2: $30 copay Tier 3: $55 copay Tier 4: $100 copay Mail Order (3 month supply) 2 times retail |
| Eligibility | First day of the calendar month following date of hire and regularly scheduled to work 20 or more hours per week. Temporary employees are ineligible. |
| 2026 Weekly Cost | If your salary is $0 – $69,999 Employee Only – $30.98 Couple – $73.90 Parent/Child(ren) – $90.69 Family – $135.00 If your salary is $70,000 – $130,000 Employee Only – $37.18 Couple – $88.68 Parent/Child(ren) – $108.83 Family – $162.00 If your salary is > $130,000 Employee Only – $41.31 Couple – $98.54 Parent/Child(ren) – $120.92 Family – $180.00 |
| 2027 Weekly Cost | If your salary is $0 – $69,999 Employee Only – $33.46 Couple – $79.81 Parent/Child(ren) – $97.92 Family – $145.78 If your salary is $70,000 – $130,000 Employee Only – $40.15 Couple – $95.78 Parent/Child(ren) – $117.51 Family – $174.94 If your salary is > $130,000 Employee Only – $44.61 Couple – $106.42 Parent/Child(ren) – $130.56 Family – $194.38 |
PPO Plan 12 Details
| Deductible | In-network: $0 |
| Coinsurance | In-network: You pay 0% Plan pays 100% |
| Out-of-Pocket Maximum | In-network: Individual: $1,500 Family: $3,000 |
| Preventive Care (typically annual physical) | In-network: $0 copay/visit |
| Primary Care Physician Office Visit | In-network: $10 copay/visit |
| Behavioral/Mental Health Office Visit | In-network: $10 copay/visit |
| Specialist Office Visit | In-network: $20 copay/visit |
| Virtual Care – Teladoc | Virtual care is available through Teladoc. Copays are typically $10 per visit, but may vary depending on the type of visit. |
| Emergency Room | In-network: You pay $75 copay/visit; waived if admitted |
| Urgent Care | In-network: You pay $20 copay/visit |
| Outpatient and Inpatient Hospital | In-network: You pay 0% Plan pays 100% |
| Prescription Drug | In Network: Retail Tier 1: $5 copay Tier 2: $20 copay Tier 3: $45 copay Tier 4: $75 copay Mail Order (3 month supply) 2 times retail |
| Eligibility | First day of the calendar month following date of hire and regularly scheduled to work 20 or more hours per week. Temporary employees are ineligible. |
| 2026 Weekly Cost | If your salary is $0 – $69,999 Employee Only – $62.27 Couple – $139.62 Parent/Child(ren) – $145.45 Family – $230.44 If your salary is $70,000 – $130,000 Employee Only – $74.73 Couple – $167.54 Parent/Child(ren) – $174.54 Family – $276.52 If your salary is > $130,000 Employee Only – $83.03 Couple – $186.16 Parent/Child(ren) – $193.93 Family – $307.25 |
| 2027 Weekly Cost | If your salary is $0 – $69,999 Employee Only – $67.27 Couple – $150.81 Parent/Child(ren) – $157.08 Family – $248.87 If your salary is $70,000 – $130,000 Employee Only – $80.73 Couple – $180.96 Parent/Child(ren) – $188.49 Family – $298.63 If your salary is > $130,000 Employee Only – $89.69 Couple – $201.08 Parent/Child(ren) – $209.43 Family – $331.82 |
Resources
Provider: Blue Cross Blue Shield
Phone: 800-800-8860 (toll-free) or 615-889-8860
For prescription services contact Sav-Rx
Sav-Rx Phone: 800-228-3108