Blue Care Elect Deductible (PPO)
With a PPO plan, you have both in-network and out-of-network coverage. However, you pay lower out-of-pocket costs when you visit in-network doctors and hospitals. Starting on July 1, 2021, this plan will have an in-network deductible of $250 per member and $500 per family.
LEARN MORE ABOUT THIS PLAN
Dependent Benefits
This plan covers dependents to the end of the month in which the dependents turn 26, even if they aren’t considered dependents on a tax return, don’t attend school, and regardless of whether or not they have a job.
Deductible cost
A deductible is the amount you pay before your insurance provider begins paying any of the costs for certain services during each calendar year. Your deductible under this plan is:
- In-network – $250 per member/$500 per family
- Out-of-network – $350 per member/$875 per family
Copayments
- Preventive care visit: Nothing
- Primary care visit: $20 per visit
- Specialist visit: $35 per visit
- Diagnostic test (x-ray, blood work): Nothing*
- Emergency Room visit: $100*
*Services are subject to the deductible.
Pharmacy Coverage
This plan gives you access to the National Preferred Formulary (NPF) for your prescription medications. The NPF is available through Express Scripts®´´, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts.
| Prescription Drug Benefit | Member Pays |
|---|---|
| Retail pharmacies (up to a 30-day supply) | $10 generic drugs $30 preferred brand drugs $55 non-preferred brand drugs |
| Mail order supply (up to a 90-day supply) | $30 generic drugs $60 preferred brand drugs $135 non-preferred brand drugs |
