Board Report June 2024

BCBS Medical Plans 2024

Current BCBS $1,600 HRA

Medical Plan

BCBS Blue Choice Options (BCO) Plan

PPO

Tier 1-BCO

PPO

Out-of-Network

Provider Type

Aggregate

Embedded

Deductible-Calendar Yr

Single

$1,600

$3,200

$4,600

$9,200

Family

$3,200

$9,200

$13,800

$27,600

Coinsurance-Plan Pays (after deductible)

80%

100%

80%

60%

Out-of-Pocket Max Single

$3,000

$3,200

$6,550

$19,650

Family

$6,000

$9,200

$14,000

$42,000

Office Visits

Deductible then 20%

Deductible then 0%

Deductible then 20%

Deductible then 40%

Emergency Room Visit

Deductible then 20%

Deductible then 0%

Deductible then 0%

Deductible then 0%

Preventive Care

100% Covered

100% Covered

100% Covered

Deductible then 40%

Prescription Drugs

Generic-Tier 1

Deductible - 20%

Deductible - 0%

Deductible - 0%

Deductible - 0%

Preferred Brand-Tier 2

Deductible - 20%

Deductible - 0%

Deductible - 0%

Deductible - 0%

Non-Preferred Brand Tier 3

Deductible - 20%

Deductible - 0%

Deductible - 0%

Deductible - 0%

Specialty Drugs Tier 4

Deductible - 20%

Deductible - 0%

Deductible - 0%

Deductible - 0%

$87.37 per month $1,048.44 Annually

District HSA Contribution

NONE

$800 Single/$1,600 Family HRA Only

District HRA Contribution

NONE