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Shared Pay Comprehensive

Affordable comprehensive protection without a deductible.

Basic plan summary
Plan type PPO (Preferred Provider Organization) – Allows you to choose to receive care from network providers of your choice.
Deductible individual $0
Deductible family $0
Coinsurance 50%
Individual out-of-pocket maximum $1,500
Family out-of-pocket maximum $3,000
Individual lifetime maximum Unlimited
Dependent coverage Eligible children covered to age 26
HSA eligibility No
Doctor office visits (illness and injury)
Office visit - history and exam 50% coinsurance
Office visit - specialist 50% coinsurance
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 50% coinsurance
Outpatient Lab/X-ray 50% coinsurance
Outpatient surgery 50% coinsurance
Hospitalization 50% coinsurance
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 50% coinsurance after $100 ind./ $200 family deductible
Brand 50% coinsurance after $100 ind./ $200 family deductible
Non-formulary 50% coinsurance after $100 ind./ $200 family deductible
Prescription drug – Mail order
Generic Not covered
Brand Not covered
Non-formulary Not covered
Maternity coverage
Pre and postnatal office visit 50% coinsurance (spouses must be enrolled in same plan)
Labor and delivery hospital stay 50% coinsurance (spouses must be enrolled in same plan)
Additional coverage
Mental health 50% coinsurance
Substance abuse 50% coinsurance
Optional benefits
Dental program Dental coverage options
Hospital Indemnity Plan (HIP) Cash benefits during hospitalization
Life insurance Protection up to $50,000
LTC Blue Long-term care insurance
Plan 150 Cancer policy

Exclusions
See the Exclusions page for details.

Additional Program Information

More Information

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