Blue Cross Small Group $30 Co-Pay Plan:

The next plan if Blue Cross’ offering is the $30 Co-Pay plan. This differs from the previously covered $35 co-pay plan by offering more options for prescription medications and lower co-payment and co-insurance amounts. As with many of the small group plans offered by Blue Cross, this plan as a lifetime maximum amount of coverage that is set at $5,000,000. This should be more than enough to cover most employee health care expenses.

Annual Deductible - The annual deductible under this plan is $500, making it very reasonable for many of your employees.

Annual Out-of-Pocket Maximum - Although the deductible under this plan is only $500, there is an out-of-pocket maximum amount of $4000 per member for participating providers. The out-of-pocket maximum for non participating providers moves up to $10,000, making it economical to visit providers who have contracted with Blue Cross under this plan.

Office Visits - These visits are not subject to the plan deductible and 12 visits are allowed per year. The co-pay for office visits from a participating physician is $30 each for the first 12 visits. After that amount has been reached, a co-insurance payment of 45% of the negotiated fee is required. Office visits with a non-participating physician are charged at 50% of the negotiated fee, and 100% of any non covered charges. For professional services from a participating physician, such as lab work or x-rays, your employees will need to pay 30% of the negotiated fee after they reach their deductible. If they require the services from a non-participating physician, the costs moves up to 50% of the negotiated fee and once again, 100% of any excess charges.

Hospital Inpatient Coverage - If your employee is admitted to a participating hospital, they will be required to pay for 30% of their care, after the plan deductible has been met. Professional services that are accrued while in a participating hospital will require a co-insurance payment of 30% after the deductible. The same care at a non-participating hospital will require 100% payment for services, minus $650 per day. Professional services received in these non-participating hospitals will be charged at 50% of the negotiated fee and 100% of any extra charges.

Outpatient Coverage - There is a requirement of a preservice review for specific procedures under this plan. If a procedure is covered, your employee will have to pay 30% of the negotiated fee for services provided by a participating plan facility or doctor. If the facility or the doctor does not participate with Blue Cross, this fee moves up to 100% of the charges over $380 per day. This care is also subjected to the plan deductible.

Prescription Drugs - This plan limits the supply that your employees may purchase of a medication. For regular pharmacy orders, they will be able to purchase a 30-day supply. For any mail order purchases, this is moved up to a 60-day supply. Participating pharmacies offer the following payment requirements under this plan: $15 for a generic prescription, $25 for a brand name prescription in the event that a generic alternative is not available and $15 plus the difference in price between the brand name and the generic prescription if a generic alternative is available. All brand name prescriptions are subject to a $150 annual deductible. Prescriptions purchased at a non-participating pharmacy require a payment of 50% of the limited fee schedule for the medication, as well as 100% of any excess uncovered charges.

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