Individual & Family Plans

Medical Plans
What are you looking for in a
health insurance plan?
  • I want more predictable out-of-pocket costs.
  • I want a lower monthly premium.
  • I want a plan with tax advantages.
  • For low-cost coverage of services like doctor's office visits and generic prescription drugs, choose...
  • If you prefer a lower monthly premium, and the comfort of knowing you'll be covered when you need it most, choose...
  • If you are looking for a health plan with the opportunity for tax advantages, choose...
Comprehensive Blue PPO III Plans HSA Blue PPO II Plan
Deductible Amount $1,000, $1,500, $2,500 OR $5,000* $7,500, $10,000, $15,000, $20,000 OR $25,000 Individual:
$1,500, $2,500 OR $5,000
Family:
$3,000, $5,000, $10,000**
Maximum Lifetime Benefit Unlimited Unlimited Unlimited
Coinsurance You pay 20% coinsurance after the deductible has been met. You pay 0% coinsurance after the deductible has been met. You pay 0% coinsurance after the deductible has been met.
Calendar-Year Coinsurance Maximum (OOPM) $2,000* Not applicable. Not applicable.
Primary Care Physician Office Visit(In-network general practitioners, pediatricians, family practitioners and internal medicine doctors.) You pay a $30 copayment. You pay a $30 copayment. You pay 0% coinsurance after the deductible has been met.
Specialist
Office Visit and Inpatient/Outpatient Services(Hospital and physician. Includes Lab and Radiology Services.) 		You pay 20% coinsurance after the deductible has been met. You pay 0% coinsurance after the deductible has been met. You pay 0% coinsurance after the deductible has been met.
Emergency Rooms(Hospital only.) You pay a $200 copayment (waived if admitted). Deductible does not apply. You pay a $200 copayment (waived if admitted). Deductible does not apply. You pay 0% coinsurance after the deductible has been met.
Children's Preventive Care Services(Immunizations and well-patient care.) You pay 0% coinsurance. Deductible does not apply. You pay 0% coinsurance. Deductible does not apply. You pay 0% coinsurance. Deductible does not apply.
Preventive Care Services You pay 0% coinsurance. Deductible does not apply. You pay 0% coinsurance. Deductible does not apply. You pay 0% coinsurance. Deductible does not apply.
Mental Health/ Substance Abuse Benefits You pay 20% coinsurance after the deductible has been met. You pay 0% coinsurance after the deductible has been met. Not covered.
Prescription Drugs You pay a $10 copayment for generic prescription drugs, a $35 copayment for preferred brand-name prescription drugs and a $70 copayment for non-preferred brand-name prescription drugs. You pay a $10 copayment for generic prescription drugs, a $35 copayment for preferred brand-name prescription drugs and a $70 copayment for non-preferred brand-name prescription drugs. You pay 0% after the deductible has been met (excludes drugs for mental health).
Formulary(drug list.) Value Formulary (PDF)
A low-cost formulary alternative that emphasizes the use of generic drugs and includes select brand-name drugs in most categories of medications. 		Value Formulary (PDF)
A low-cost formulary alternative that emphasizes the use of generic drugs and includes select brand-name drugs in most categories of medications. 		Formulary Two (PDF)
A more comprehensive formulary but it does not cover any drugs related to mental health.
Optional Maternity Benefits You pay 20% coinsurance after the deductible has been met. Coinsurance does not apply toward the calendar-year coinsurance maximum. You pay 0% coinsurance after the deductible has been met. You pay 0% coinsurance after the deductible has been met.
Tax Advantages Available No. No. With purchase of an HSA.
12-Month Rate Guarantee Yes. Yes. Yes.
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*Maximum of 2 deductibles/calendar-year coinsurance maximums per family, per calendar year.
**Aggregate family deductible. Aggregate deductible means the total expenses from family members-in any combination-can be used to meet the deductible.