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 full cost 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.
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.
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|
|2019 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.
Here are your premium costs for the medical plans.
|CDHP||Basic PPO||Enhanced PPO|
|Employee and children||$116.46||$252.33||$127.68||$276.64||$240.95||$522.05|
|Employee and spouse||$133.02||$288.22||$156.67||$339.45||$295.02||$639.22|
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.