Blue Cross Small Group $35 Co-pay GenRx Plan:

The next plan offered by Blue Cross for small group health coverage is the $35 Co-pay GenRx plan. This plan offers a different prescription benefit and calculates other benefits a little differently from the other plans. Here’s what you can expect.

Annual Deductible - The annual deductible for this plan is $500. This deductible includes all medical services, except office visits, prescriptions and Healthy Check screenings.

Lifetime Maximum - The lifetime maximum benefit amount for this plan is $5,000,000, much like Blue Cross’ other plans.

Annual Out-of-Pocket Maximum - The maximum amount that your employees’ will spend out of their own pockets for their health care under this plan is $4000 for participating providers. There is a $10,000 maximum for non-participating providers, but once this amount is reached, there are no further expenses for that year.

Office Visits - There is a $35 co-pay for office visits, with a maximum of 12 covered visits per year. If you go beyond 12 visits in one year, your employees will have to pay 45% of the negotiated fee. For non participating providers, there is no co-pay, but your employees will have to pay 50% of the negotiated fee for an office visit, as well as 100% of any charges that are not covered by the plan. For professional services that are not classified as an office visit, the charges are a little different. For participating provider professional services, your employees will need to pay for 35% of the negotiated fee, once they have met their deductible. If professional services are provided by a non-participating member, this charge moves up to 50% of the negotiated fee and 100% of any non-covered expenses.

Hospital Inpatient Care - For a participating hospital, your employees will need to pay 35% of the negotiated fee for their care, after they have met their deductible. If they receive inpatient care at a non-participating hospital, this fee moves up to 100% of all charges, minus the $650 payment provided by this plan. Professional services received as an inpatient from a participating hospital will also be charged at 35% of the negotiated fee, after the plan deductible is met. Non-participating professional services are charged at 50% of the negotiated fee and 100% of any excess charges.

Outpatient Care - Once again, the charge for outpatient care from a participating provider is 35% of the negotiated fee. Non-participating provider outpatient care requires 100% payment, minus the $380 payment provided per day under this plan. This care is subject to the plan deductible.

Prescription Drugs - As you may gather from the name of this plan, the Co-Pay GenRx plan does not cover brand name medications. Only generic prescriptions will be covered by this plan and will require a $15 co-pay. However, these prescriptions are not subject to your employees’ deductible. If your employees’ visit a non-participating pharmacy, the charges for their medications increase to 50% of the limited fee schedule and 100% of any uncovered charges.

Healthy Check Screenings - Your employees will be able to select either the $25 Healthy Check option or the $75 Healthy Check option. These screenings are not subject to the plan deductible. Healthy Check screenings are not available from non-participating providers.

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