* If you live in California, you also have a Health Maintenance Option (HMO) available. See below for details.
How Are the Plans Alike?
All three plans:
- Cover the same services, such as doctor’s office visits, hospitalization, emergency room care and prescription drugs.
- Pay 100% for in-network preventive care, such as routine physicals, well-woman exams, well-baby exams, blood pressure checks, cholesterol tests and cancer screenings.
- Let you see any doctor but offer savings when you use Blue Cross Blue Shield in-network doctors.
How Are the Plans Different?
- No copays with this plan. You pay the contracted, negotiated rate of care (except for in-network preventive care) until you meet the deductible. After you meet the deductible, you and the plan share the cost of care.
- Company-funded HSA to help you pay for care; you can add money of your own, too.
- Lowest paycheck contributions of all three plans, but you’ll have to meet higher deductibles.
- Copays for some services such as doctor’s office visits; for other services such as hospitalization, you must meet the deductible and then you and the plan share costs (coinsurance).
- Lower deductibles than the CDHP, so your paycheck contributions are higher.
- No company-funded Health Savings Account (HSA).
Find the Right Fit: Your Medical Plan Options
Trying to decide which plan to choose? Learn how the plans work and which may be the best choice for you.
How the Plans Work
Here’s a step-by-step look at how the plans work.
Step 1: Set Up Your HSA
The company adds money to your account: $1,000 for employee-only or employee and spouse coverage or $2,000 for employee and children or family coverage. You can also contribute pre-tax money of your own, up to IRS limits.
Step 2: Pay Toward Your Deductible
You pay 100% of the cost for medical care and prescription drugs (except for in-network preventive care) until you meet your deductible. You can use your HSA to help you pay for care before you have to dip into your own pocket.
Step 3: Share Costs With the Plan
Once you meet your deductible, you’ll share costs with the plan — using money from your HSA or wallet — until you meet the out-of-pocket maximum.
Step 4: The Plan Pays the Rest
If you reach your out-of-pocket maximum, the plan will pay 100% of your eligible expenses for the rest of the plan year.
Basic & Enhanced PPO
Step 1: You Pay for Care
You pay copays for doctor’s office visits and prescription drugs. You don’t have to meet the deductible for these services. Copays do not count toward your deductible but do count toward your out-of-pocket maximum.
Step 2: Share Costs With the Plan
For other services, such as hospitalization, you must meet your deductible before the plan shares costs.
Step 3: The Plan Pays the Rest
If you reach your out-of-pocket maximum, the plan will pay 100% of your eligible expenses for the rest of the plan year
Anytime, Anywhere Care, @Work or @Home*
Talk to a doctor 24/7 from your computer, smartphone or tablet. MDLive doctors can answer your questions, make a diagnosis and even prescribe basic medications (subject to availability by state). You and your covered family members can use this benefit if you’re enrolled in a TEAM medical plan. For the CDHP, you’ll pay 20% after the deductible. For the PPO plans, you’ll pay your PCP copay. To use MDLive, visit members.mdlive.com/bcbstx or call 888-680-8646.
*Available if enrolled in BCBS of TX CDHP or PPO.
Medical Plans at a Glance
With all three plans, you can see any provider. But if you visit an in-network provider, you’ll get services at the lower negotiated rate. If you use an out-of-network provider, you’ll get a lower level of coverage and your costs will be higher. Find an in-network provider by visiting bcbstx.com or calling 800-521-2227. Here’s a look at what you’ll pay when you need care.
|CDHP||Basic PPO||Enhanced PPO|
|2020 Health Savings Account (HSA) Contributions from TEAM|
|Employee only or employee and spouse||$1,000||No contribution||No contribution|
|Employee and children or family||$2,000||No contribution||No contribution|
|Deductible (The amount you must pay benefits for some services. Amounts you pay towards the the deductible count toward your out-of-pocket maximum.)|
|What you pay|
|Preventive care2||$0||50% after deductible||$0||60% after deductible||$0||40% after deductible|
|Office visits||20% after deductible||50% after deductible||$15 copay for Blue Distinction provider; $30 copay for primary care physician (PCP); $40 copay for specialist; $35 copay for urgent care||60% after deductible||$15 copay for Blue Distinction provider; $25 copay for primary care physician (PCP); $35 copay for specialist; $35 copay for urgent care||40% after deductible|
|Virtual visits||20% after deductible||N/A||$30 copay||N/A||$25 copay||N/A|
|Maternity care||20% after deductible||50% after deductible||$30 PCP copay/$40 specialist copay, then 30% of remaining eligible expenses after deductible||60% after deductible||$25 PCP copay/$35 specialist copay, then 20% of remaining eligible expenses after deductible||40% after deductible|
|Inpatient hospital3||20% after deductible||50% after deductible4||$250 copay per admission, then 30% after deductible||$500 copay per admission, then 60% after deductible4||20% after deductible||$500 copay per admission, then 40% after deductible4|
|Outpatient surgery||20% after deductible||50% after deductible||30% after deductible||60% after deductible||20% after deductible||40% after deductible|
|Emergency care5||20% after deductible||30% after deductible||$250 copay (waived if admitted)|
|Out-of-pocket maximum6 (The maximum amount you will have to pay out of pocket for the plan year. If you reach this limit, the plan will pay 100% of your eligible expenses for the rest of the plan year.)|
- If you use an out-of-network provider, you are responsible for any charges above the reasonable and customary limit.
- Plan pays 100% for in-network preventive care based on Blue Cross Blue Shield’s preventive care guidelines.
- Pre-certification required.
- You pay a $350 penalty if you fail to pre-certify your hospital stay.
- Care Coordination must be notified within 2 days. Coverage for true emergencies only.
- Expenses that count toward meeting your out-of-pocket maximum include medical plan coinsurance and copays, prescription drug coinsurance and copays and amounts you pay toward the deductible. Amounts above the reasonable and customary charge for out-of-network care do not count toward your out-of-pocket maximum.
Kaiser HMO at a Glance (California only)
If you live in California, you have another medical option available: the Kaiser HMO.
With this plan, you must use in-network doctors to receive benefits — there is no out-of-network coverage except for urgent care and emergencies. You pay set copays for services, and there’s no deductible to meet. To find a provider, visit kp.org or call 800-464-4000.
|Kaiser HMO (California only)|
|What you pay|
|Office visits||$20 copay|
|X-rays and lab tests||$0|
|Outpatient surgery||$20 copay|
|Emergency care||ER visit: $100 copay (waived if admitted)
Ambulance: $50 copay
|Out-of-pocket maximum2 (The maximum amount you will have to pay out of pocket for the plan year. If you reach this limit, the plan will pay 100% of your eligible expenses for the rest of the plan year.)|
- Plan pays 100% for preventive care based on Kaiser’s preventive care guidelines.
- Expenses that count toward meeting your out-of-pocket maximum include medical plan copays and prescription drug copays and coinsurance.
CDHP and PPO Paycheck Costs
Here are the premium for the CDHP and PPOs.
|CDHP||Basic PPO||Enhanced PPO|
|Employee and children||$120.00||$260.00||$153.69||$333.00||$279.23||$605.00|
|Employee and spouse||$137.08||$297.00||$188.31||$408.00||$342.00||$741.00|
Kaiser HMO Paycheck Costs (California Only)
Here are your premium costs for the Kaiser HMO.
|Employee and children||$191.54||$415.00|
|Employee and spouse||$210.46||$456.00|
If you use tobacco products (cigarettes, chew and/or electronic cigarettes), you’ll pay an additional $125 per month for your medical benefits. This surcharge will be waived if you’re participating in a smoking cessation program at the time you enroll. For more information on the smoking cessation program, contact Blue Cross Blue Shield at 866-412-8795.
To help keep our costs down, we’ve added a spousal surcharge. If your spouse has other coverage available through his or her employer and you enroll your spouse in a TEAM medical plan, you’ll pay a spousal surcharge of $150 per month.