Our Comprehensive Major Medical plan is our most complete health care package offering flexible affordability. Coverage includes hospital, surgical, medical, accident, even maternity and newborn benefits. Plus, the comprehensive care you receive is provided by your choice of doctors and hospitals from our comprehensive network – 98% of all health care providers in our service area. And by giving you a choice of deductibles, you can tailor the cost to fit your budget. It’s difficult to find a plan that’s more comprehensive, more reliable, and more affordable.
Benefit Summary (Benefits include but are not limited to:)
Office Visit & Services
Your office visit copay is $25 per visit for unlimited visits. You pay the $25 copay and Comprehensive Major Medical plan pays the remaining charges for:
Paid at 100 percent of the allowable charge. Includes routine screenings, immunizations, checkups and counseling received to prevent illness or disease.
Your dependents are covered to age 26.
The BlueRxSM Card prescription drug program provides savings using a three-tiered benefit. Copay is $15 for generic drugs, $30 for formulary brand drugs and $45 for non-formulary brand drugs. Mail order drugs have a copay of 2 ½ times retail copay.
With Comprehensive Major Medical, each person covered has an unlimited lifetime maximum benefit.
Deductibles and Coinsurance: A choice of deductibles is available:
After meeting your deductible, you pay 20% coinsurance (Blue Cross pays the other 80%) to a maximum out-of-pocket expense of $1,000 for each person ($2,000 for two or more person coverage). After the out-of-pocket maximum is met, Blue Cross pays 100% of the allowed charges for covered services for the remainder of your 12-month benefit period.
Covered Services include:
See the Exclusions page for details.
Additional Program Information
Triple Option Plan
The Triple Option Plan is available to large groups with this product. The plan offers employees one of three out-of-pocket choices annually within the Shared Pay Comprehensive 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.
Contact us to learn more about the features of Comprehensive Major Medical.