Review Your Benefit Options

Medical Benefits

Overview

You have two medical plan options: the Premier Plan and the Value Plan. Both plans are administered by BlueCross BlueShield (BCBS) and provide the maximum benefits when a BCBS provider is used for services. There is a $3,500 secondary insurance through Medplus/Gulf Guaranty.

NOTE: The out-of-pocket maximum excludes office visits and prescription drug co-pays.

	Premier Plan	Value Plan
	In-Network	In-Network
Office Copay (PCP/SPC) Single/Family	$45 / $65 specialist	$45 / $65
Other Copay (IP/ER/UC) Single/Family	Subject to ded / 80%	$40 / 80%
Deductible Single/Family	$500 / $1,000	$4,000 / $8,000
Out-of-Pocket Single/Family	$3,300 / $6,600	$6,800 / $13,600
Coinsurance	In / Out-Patient – 80%	In / Out-Patient – 80%
Pharmacy	$15 / $60 / $100 / $425	$15 / $60 / $100 / $425

	Premier Plan	Value Plan
	Out-of-Network	Out-of-Network
Deductible Single/Family	$8,000 / $16,000	$8,000 / $16,000
Out-of-Pocket Single/Family	N/A	N/A
Coinsurance	100% / 50%	80% / 50%

Medical Rates (Monthly)

Coverage Tier	Premier Plan	Value Plan
Employee Only	$661.10	$583.32
Employee + Spouse	$1,384.19	$1213.07
Employee + Children	$1,130.10	$986.20
Family	$1,963.88	$1,726.64