2022 - 2023 Benefits Guide

For a brief overview of the two plans, please see the following comparison chart. This chart will allow you to compare the two plans side by side. MEDICAL PLAN SUMMARY COMPARISON CHART The table below reflects an overview of some of the more common services used.

BCBS PPO

BCBS HDHP

OUT-OF- NETWORK

Services you may need Deductible Credit from Prior Credit Coinsurance Stop-loss Credit from Prior Carrier Calendar Year Deductible Individual

IN-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Yes

Yes

Yes

Yes

Yes

No

Yes

No

$5,000 $10,000

$14,700 $29,400

$6,000 $12,000

$12,000 $24,0000

Family

Coinsurance Stop-loss Maximum per cal. year Individual $5,600

Unlimited Unlimited

$6,000 $12.000

Unlimited Unlimited

Family

$14,700

Office Visits

Primary Care Physician

$45 copay $90 copay

100% after cal yr deductible

50% coinsurance

30% coinsurance

Specialist

Virtual Visit (MD Live)

$0 copay

$44 copay

Preventative care

Preventive Care/Screening (Routine Physicals)

No charge; deductible does not apply

No charge; deductible does not apply

50% coinsurance

30% coinsurance

Diagnostic Testing

No charge; deductible does not apply

100% after cal yr deductible

X-Ray / Blood work

50% coinsurance

30% coinsurance

Other Diagnostic Procedures Imaging (CT/PET scans, MRIs)

100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible

30% coinsurance

50% coinsurance

30% coinsurance

Durable Medical Equipment

30% coinsurance

50% coinsurance

30% coinsurance

Physician/Surgeon Fees

30% coinsurance

50% coinsurance

30% coinsurance

Urgent Care

$75 copay

50% coinsurance

30% coinsurance

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