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.
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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.
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
- 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.
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)||$20 generic drugs
$60 preferred brand drugs
$135 non-preferred brand drugs