Your safety net for comprehensive, affordable health care.
| Basic plan summary | |
|---|---|
| Plan type | PPO (Preferred Provider Organization) – Allows you to choose to receive care from network providers of your choice. |
| Deductible individual | $2,500 / $3,000 / $5,000 |
| Deductible family | $5,000 / $6,000 / $10,000 |
| Coinsurance | No coinsurance |
| Individual out-of-pocket maximum after deductible | None |
| Family out-of-pocket maximum after deductible | None |
| Individual lifetime maximum | Unlimited |
| Dependent coverage | Eligible children covered to age 26 |
| HSA eligibility | Yes |
| Doctor office visits (illness and injury) | |
| Office visit - history and exam | Subject to deductible |
| Office visit - specialist | Subject to deductible |
| How can I find a doctor in this plan's Network? | Search for a doctor or hospital here |
| Do I need permission from my primary care doctor to see a specialist? | No |
| Do I need authorization before seeing an out-of-network doctor? | No |
| Hospital services | Your cost sharing |
| Emergency room | Subject to deductible |
| Outpatient Lab/X-ray | Subject to deductible |
| Outpatient surgery | Subject to deductible |
| Hospitalization | Subject to deductible |
| Preventive care | |
| As part of the Affordable Care Act, preventive services are paid at 100% of the allowable charge for new enrollees after Sept. 23, 2010. This includes routine screenings, immunizations, checkups and counseling received to prevent illness or disease. There are also several preventive services for women paid at 100% of the allowable charge for new enrollees on or after Aug. 1, 2012. For a complete listing, please click here. | |
| Prescription drug | |
| Generic | Subject to deductible |
| Brand | Subject to deductible |
| Non-formulary | Subject to deductible |
| Prescription drug – Mail order | |
| Generic | Not covered |
| Brand | Not covered |
| Non-formulary | Not covered |
| Maternity coverage | |
| Pre and postnatal office visit | Subject to deductible |
| Labor and delivery hospital stay | Subject to deductible |
| Additional coverage | |
| Mental health | Subject to deductible |
| Substance abuse | Subject to deductible |
| Optional benefits | |
| Dental program | Dental coverage options |
| Hospital Indemnity Plan (HIP) | Cash benefits during hospitalization |
| Life insurance | Life coverage options |
| LTC Blue | Long-term care insurance |
| Plan 150 | Cancer policy |
Exclusions
See the Exclusions page for details.
Additional Program Information
Triple Option Plan
The Triple Option Plan is available to groups of 2 to 99 employees with this product. The plan offers employees one of three out-of-pocket choices annually within the Comprehensive Major Medical benefit program. The employer must contribute at least 25 percent of the employee-only premium amount for the highest out-of-pocket option. This stabilizes the group's base and gives the employees the option to "buy up" to a better level of coverage, based on their personal insurance needs.
More Information