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Blue Copay

A copayment (or copay) is a fixed amount you pay for a covered health care service. The amount can vary by the type of covered health care service. Blue Copay is designed with a variety of copays built into the plan to help lower the amount of your health insurance premium. Blue Copay is comprehensive, reliable and affordable. Your coverage includes hospital, surgical, medical, accident and maternity care – and all with no deductible and no coinsurance.

Learn how the Blue Choice network enhances your Blue Copay coverage

Benefit Summary (Benefits include but are not limited to:)

Office Visit & Services
Your Primary care office visit copay is $30.
Your Specialist office visit copay is $80.

Services listed below are subject to appropriate copays.

• Hearing tests and eye examinations
• Mental illness and substance use disorders
• Short-term therapies (visitation limits apply)

Preventive Care
Paid at 100 percent of the allowable charge. Includes routine screenings, immunizations, checkups and counseling received to prevent illness or disease.

Dependents
Your dependents are covered to age 26.

Prescription Drugs
The BlueRx Card^SM prescription drug program provides savings using a four-tiered benefit. (If generics are available for a prescription, they must be used.) Copay is $15 for generic drugs, $50 for formulary brand drugs, $75 for non-formulary brand drugs and $150 for specialty drugs. Mail order drugs have a copay of 2 ½ times the retail copay.

Lifetime Maximum
With Blue Copay, each person covered has an unlimited lifetime maximum benefit.

Deductibles and Coinsurance

Blue Copay plan uses a variety of copays in place of deductibles and coinsurance.

Covered Services include:

• Maternity & newborn services
• In-hospital care
• Ambulance services
• Surgery & anesthesia
• Outpatient surgery
• Mental illness & substance use disorders
• Outpatient radiology & lab services
• Accidental injuries (100% up to $1,000)
• Home health care and hospice services

Optional Benefits:

• Dental Program
• Hospital Indemnity Program
• Life Insurance
• Long-term Care Insurance
• Plan 150 (Cancer Policy)

Exclusions
See the Exclusions page for details.

Additional Program Information

• Inpatient Admissions - Pre-admission certification is required for all planned inpatient admissions.
• Benefit Period - The 12-month period based on the group anniversary month.
• Waiting Period - Businesses select a waiting period option.

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 Blue Copay 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
Contact us to learn more about the features of Comprehensive Major Medical.