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 12 Details
| Deductible | In-network: Single: $2,000 Family: $4,000 |
| Coinsurance | In-network: You pay 30% Plan pays 70% |
| Out-of-Pocket Maximum | In-network: Individual: $6,350 Family: $12,700 |
| Doctor’s Office Visit | In-network: You pay $30 copay/visit |
| Specialist Office Visit | In-network: You pay $50 copay/visit |
| Virtual Care – MDLive | Virtual care is covered at a $30 copay through MDLive. Look in the plan documents section for more information. |
| Preventive Care/Well Child Care | In-network: You pay $0 Plan pays 100% |
| Emergency Room | In-network: You pay $200 copay/visit; waived if admitted |
| Urgent Care | In-network: You pay $50 copay/visit |
| Hospitalization | In-network: You pay 30% (after deductible) Plan pays 70% |
| Prescription Drug | In Network: Retail Tier 1: $15 Copay Tier 2: $35 Copay Tier 3: $75 Copay Mail Order Tier 1: $38 Copay Tier 2: $88 Copay Tier 3: $188 Copay |
| 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. |
| 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 |
PPO Plan 14 Details
| Deductible | In-network: $0 |
| Coinsurance | In-network: You pay 0% Plan pays 100% |
| Out-of-Pocket Maximum | In-network: Individual: $2,500 Family: $5,000 |
| Doctor’s Office Visit | In-network: You pay $15 copay/visit |
| Specialist Office Visit | In-network: You pay $15 copay/visit |
| Virtual Care – MDLive | Virtual care is covered a $15 copay through MDLive. Look in the plan documents section for more information. |
| Preventive Care/Well Child Care | In-network: You pay $0 Plan pays 100% |
| Emergency Room | In-network: You pay $150 copay/visit; waived if admitted |
| Urgent Care | In-network: You pay $15 copay/visit |
| Hospitalization | In-network: You pay 0% Plan pays 100% |
| Prescription Drug | In Network: Retail Tier 1: $10 Copay Tier 2: $25 Copay Tier 3: $50 Copay Mail Order Tier 1: $25 Copay Tier 2: $63 Copay Tier 3: $125 Copay |
| 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. |
| 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 |
Resources
Provider: Blue Cross Blue Shield
Phone: 800-331-1476