2025-2026 EAA Benefits Guide

MEDICAL PLAN SUMMARY COMPARISON CHART

BCBS PPO

BCBS HDHP

OUT-OF- NETWORK

Services you may need

IN-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Calendar Year Deductible Individual

$5,250 $15,750

$10,500 $31,500

$6,000 $12,000

$12,000 $24,0000

Family

Coinsurance Out-of-Pocket Max per cal. year Individual $5,850

Unlimited Unlimited

$6,000 $12.000

Unlimited Unlimited

Family

$17,550

Office Visits

Primary Care Physician

$50 copay $100 copay

100% after cal yr deductible

50% coinsurance

30% coinsurance

Specialist

Virtual Visit (MD Live)

$0 copay

$44 copay

Preventative care

Preventive Care/Screening/ Immunization

No charge; deductible does not apply

No charge; deductible does not apply

50% coinsurance

30% coinsurance

Diagnostic Testing

No charge; deductible does not apply

No charge; deductible does not apply

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

$500 copay/visit plus 30% coinsurance (Copay waived if admitted)

$500 copay/visit plus 30% coinsurance

100% after cal yr deductible

100% after cal yr deductible

Emergency Room Care

Non-Emergency Situations (Preauthorization required) Facility Charges (Hospital room) 30% coinsurance

100% after cal yr deductible

50% coinsurance

30% coinsurance

Physician/Surgeon Fees

Emergency Medical Transportation

100% after cal yr deductible

100% after cal yr deductible

30% coinsurance

30% coinsurance

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