No obligation to enroll. Contact your tax or legal professional to discuss details regarding your individual business circumstances. This message may appear if the member has a 12 visit benefit limit for chiropractic services. You should also have the members medical record available since you will be asked multiple questions about the members diagnosis(es), medical history, and treatment plan. Prescription Drugs - Your cost share for specialty prescription drugs. Appropriate ratio of controller medications to total asthma medications. Costs & Network Members say that their doctors know about care from other providers. This information can help you if you're shopping for health insurance and want to learn how HMO and PPO plans are different. Tier 2: $6,000 Your deductible is $1,250 per member (or $2,500per family). Dental - Does the plan cover Orthodontics? How Health Insurance Works What's the difference between HMO and PPO plans? Click Submit. Member Cost with Medicare Advantage (Part C) Primary - If a plan reimburses you for your Part B premiums, this displays the maximum amount that you will be annually reimbursed. Annual Deductible: The amount you may have to pay for covered health care services before the plan begins to pay. Are being treated by a Blue Cross Blue Shield of Massachusetts-contracted chiropractor. Check premiums on our website at www.opm.gov/fehbpremiums . Duke Human Resources Standard High Bronze: HMO Blue Basic Deductible Chiropractic Services - Blue Cross Blue Shield of Massachusetts Surgery & Hospital Charges - This is the amount you pay for covered Room & Board charges while an inpatient in a hospital. How are HMO and PPO plans different? | FAQs | bcbsm.com or D.O., but can include other licensed providers). OPM is currently leading Hiring the Best Talent efforts to identify issues or challenges in Federal employment. 1. Use ConnectCenterto see if the member requires authorization. Tier 3: $150 no deductible, Tier 1: $600/day1 Schedule of Benefits. Then his plan starts sharing up to 80 percent of the cost. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov. When you join HMO Blue, you must choose a primary care physician (PCP) for you and each member of your family. Our quoting tool is provided for your information only. Tier 2: $0 Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Enrollees who wish to cover one eligible family member are free to elect either the Self and Family or Self Plus One enrollment type. Medical | Blue Cross and Blue Shield of Illinois including buying individual insurance coverage through the Health Insurance Marketplace. 155.220(c) and (d) and standards established under 45 C.F.R. When you have Medicare C, some plans will waive the copay. If you receive an adverse determination and want to appeal the determination, you will have two options for reconsideration. In September, you break your arm. No obligation to enroll. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces. The following chart gives an overview of the differences between the four medical plans. You wake up with a toothache. Developing senior leaders in the U.S. Government through Leadership for a Democratic Society, Custom Programs and Interagency Courses. HMO Blue Basic Copayment. Follow-up appointment within 30 days of discharge. This chart compares Independence Blue Cross health plan benefits and estimated out-of-pocket costs for in-network services, including doctor and hospital visits, specialty care, and prescription drugs. Since I travel a lot, can I see doctors in other locations around the world? When an email goes out about an authorization that has posted to the site, the email will be directed to that preferred email address. Our quoting tool is provided for your information only. Schedule of Benefits (continued) HMO Blue Basic Deductible This chart shows your cost share for covered services. 1 HMO Gold Classic and HMO Silver Basic are only available for purchase through the Pennsylvania Insurance Exchange (Pennie). Dental - Does the plan cover Major Restorative for Adults (e.g., endodontics, crowns, prosthodontics)? Premium subsidies vary by address and subject to eligibility. Member Cost with Medicare A & B Primary - This is the amount you pay for an inpatient hospital stay. Cost sharing (deductibles and coinsurance) may be higher. You must pay all charges in excess of a benefit limit. When you have Medicare A and B, some plans waive this amount. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Under Eligibility, look for Chiropractic. Chiropractors should request authorization for chiropractic services for certain Blue Cross Blue Shield of Massachusetts members. Service and product availability varies by state. $925 Mastercard Flex Card to pay for out-of-pocket expenses. With a Keystone HMO plan from Independence Blue Cross, you can see any doctor or visit any hospital in the Keystone Health Plan East network. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. A net deductible is the sum of your deductible minus any medical account fund. 2. Receives services inside or outside of Massachusetts. Tier 3: $45, Tier 1: $40 PDF Schedule of Benefits Your next thought is:Read More, Got a summer safety plan for your kids? traditional coverage begins. 1 Amount shown reflects copay per day. Member Cost with Medicare A & B Primary - This is the amount you pay for a primary care visit. Tier 2: $8,000 When a message is posted, you get an email. Flexible plan design options with deductible/coinsurance and copay . All quotes are estimates and are not final until consumer is enrolled. Attention: This website is operated by HealthMarkets Insurance Agency and is not the Health Insurance Marketplace website. always refer to the individual FEHB brochure which is the official statement of benefits. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. They may also qualify for a zero-dollar premium bronze plan (after tax credits). Tier 3: $6,000, Tier 1: $40 Out-of-network benefits limited to 20 days per calendar year for Duke Select, Duke Basic, and Blue Care. and SM Service Marks are the property of their respective owners. $0 premium plus a $30/month Part B Give Back. Primary/Specialty Care - The amount you pay for a visit to a provider focusing on a specific area of medicine. PDF Summary of Benefits and Coverage: What this Plan Covers & What You Pay Your PCP will treat you for general health needs and refer you to specialists as needed. Recruit, Retain and Honor a World-Class Workforce to Serve the American People. Treatment Therapies - This is the amount you pay for Applied Behavior Analysis (ABA) coverage. Summary Plan Descriptions & Required Notices, Employee Occupational Health & Wellness (EOHW), Professional Development Course Offerings, Duke USA PPO (for out-of-state employees), Behavioral Health and Substance Abuse Benefits, Changes for 2020 and 2021 Reimbursement Accounts, Faculty/Staff Retirement Plan (Non-Exempt), Duke's Contribution for Housestaff & Post-doctoral Associates, Self-Directed Brokerage Account (BrokerageLink), Holidays, Vacation & Sick Time (University), Paid Parental Leave Changes - August 3, 2020, Kiel Memorial Vacation/PTO Donation Program, Online Application for Participating Schools, Department Manager & Payroll Representative Info, Post-Retirement Group Term Life Insurance, Information for 4th Quarter (Oct - Dec) New Hires, Summary Annual Report for the Welfare & Fringe Benefits Plan, Summary Annual Report for Faculty/Staff Retirement Plan, Summary Annual Report for the Retiree Health Plan, Well visits not covered; you pay 30% after deductible, $20 co-pay primary care or $55 co-pay specialist first visit, then professional services covered in full, $75 co-pay specialist first visit, then professional services covered in full, $20 co-pay first visit, then professional services covered in full, Subject to $600 annual deductible; you pay 10% co-insurance, 70% after $900 per admission co-pay and deductible, You pay 10% after deductible when medically necessary, Provided only at the Duke Fertility Center, Does not include COH, IVF, or other types of artificial conception, Infertility Testing and Treatment, Subject to Precertification, Fixed price; precertification required; limits apply, $20 co-pay primary care; $55 co-pay specialist; covered in full for testing, Covered in full when authorized by doctor; 60-day annual maximum, You pay 10% after deductible when authorized after $250 per admission co-pay; 60-day annual maximum, Covered in full when authorized by doctor; up to 100 visits per calendar year, $25 co-pay per visit when authorized by doctor; up to 100 visits per calendar year, You pay 10% after deductible when authorized; 100 combined in- and out-of-network visits per calendar year, Covered in full when authorized by doctor, $20 co-pay; 40 visits per calendar year for combined PT and OT, $75 co-pay; 40 visits per calendar year for combined PT and OT, $55 co-pay for PT and OT; 40 visits per calendar year for combined PT and OT, $55 co-pay; 40 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network, You pay 30% after deductible; 40 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network, Covered in full up to 6 visits per calendar year, $20 co-pay; 20 visits per calendar year; precertification required, $75 co-pay; 20 visits per calendar year; precertification required, $55 co-pay; 20 visits per calendar year for combined in- and out-of-network, $20 co-pay; limit 1 per calendar year; 30% lens and frame discount at point of purchase; 15% disposable contacts discount at point of purchase, $55 co-pay; limit 1 per calendar year; 30% lens and frame discount at point of purchase; 15% disposable contacts discount at point of purchase, $600 per admission co-pay applies; must be pre-certified, You pay 30% after $900 per admission co-pay and deductible, Prenatal care only (labor and delivery are excluded). Durham, NC 27705 This website may not display all data on Qualified Health Plans (QHPs) being offered in your state through the Health Insurance Marketplace website. Primary/Specialty Care - The amount you pay for a visit to a primary care practitioner (typically an M.D. Emergency & Urgent Care - Is a member's Out-of-Pocket cost waived when the member is admitted to the hospital following ER treatment? Authorization information appears in the fields under Message and Auth/Cert Required. Tier 1: $0 How to check member benefits and eligibility, Information to have ready when making authorization requests, Tips for using the Rapid Response System to make authorization requests, Requesting a peer-to-peer discussion or an appeal, Understanding benefits information in ConnectCenter. PDF Summary of Benefits and Coverage: What this Plan Covers & What You Pay Sales agents may be compensated based on a consumers enrollment in a health plan. In those plans, if you dont get a referral first, the plan may not pay for the services. Call a licensed agent to learn more about your health options at. Health Insurance Deductible: How It Works, Types - Verywell Health Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for an inpatient hospital stay. PDF the cost for covered health care services. NOTE: Information about the Like the name says, this type of plan's deductible is higher than most traditional plans. Please consult the plan brochure for more information. Not all agents are licensed to sell all products. PDF Blue Cross Blue Shield of Massachusetts Coverage. All rights reserved. Tier 3: $140 no deductible, Tier 1: $5,000 Dental - Does the plan cover Preventive Dental for Adults? Registered Marks of the Blue Cross and Blue Shield Association. Access Blue Select Saver $2,000. Go Back. People with high blood pressure receive effective treatment. Emergency & Urgent Care - What is the member cost share for Urgent Care? PDF Network Blue BCBSMA Employee Plan New England $1,250 Deductible Depending on the plan, some basic services (like doctor visits and prescriptions) may be covered before your deductible is met. Surgery & Hospital Charges - This is the amount you pay for a doctor to perform surgery in an outpatient hospital setting or ambulatory surgery center. Prescription Drugs - This is the amount you pay for a mail order prescription. Keystone HMO Silver Basic: $5,500. Access Blue Basic. Emergency/urgent care only. For example, if your coinsurance is 80/20, it means that your insurance pays 80% and you pay 20% of the bill after you've met your annual deductible. Tier 2: Subject to deductible and $900/day1 Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Complex Diagnostic Tests/Procedures (e.g., CT scans, MRIs, PET scans, sleep labs)? Independence Blue Cross is a subsidiary of Independence Health Group, Inc. independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania, Sitemap | Legal | Privacy & other policies | Anti-fraud | Developer resources, Language access: Espaol | / | Tagalog | Franais | Ting Vit | Deutsche | | | | | | | Italiano | Portugus | Kreyl | Jzyk | Polski | | Pennsylvania Deitsch | | Din bizaad, The widest choice for quality care in the region, Comprehensive plans for every business size and budget, Affordable Medicare health and prescription drug plans that meet your needs, Find a particular provider, specialist, hospital, or specialty facility, Understand and maximize your prescription drug benefits, Resources to support your behavioral, physical and emotional health, Exclusive programs and tools designed to help you live a healthier life, Free classes and seminars for IBX members, Convenient online resources and services for our groups, Everything you need to sell Independence Blue Cross, Find doctors, hospitals, medical equipment, and specialty services, Children's Health Insurance Program (CHIP), Critical illness, accident, and cancer insurance, Critical illness, accident and cancer insurance, Uprise Health Employee Assistance Program, Precertification and cost-share requirements, Medical policy and precertification inquiry, Provider communications email sign up form, Claims requiring submission of clinical information, What is a Health Maintenance Organization (HMO)?, Find out which health providers are available in these plans, Learn the differences between an HMO plan and a PPO plan, $20 no deductible (integrated with medical deductible), $25 no deductible (integrated with medical deductible), You want to save money by selecting health care providers in the Independence Keystone Health Plan East, You have or are willing to designate a primary care physician to coordinate all of your healthcare and provide referrals for specialty care, Still have questions about the Keystone HMO health plans? PDF Schedule of Benefits - Blue Cross Blue Shield of Massachusetts Please check benefits and eligibility to determine if authorization is required. 3. Self Self Plus One Self & Family Plan Selection Comparison Tool The information contained in this comparison tool is not the official statement of benefits. Independence Blue Cross is a subsidiary of Independence Health Group, Inc. independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania, Sitemap | Legal | Privacy & other policies | Anti-fraud | Developer resources, Language access: Espaol | / | Tagalog | Franais | Ting Vit | Deutsche | | | | | | | Italiano | Portugus | Kreyl | Jzyk | Polski | | Pennsylvania Deitsch | | Din bizaad, The widest choice for quality care in the region, Comprehensive plans for every business size and budget, Affordable Medicare health and prescription drug plans that meet your needs, Find a particular provider, specialist, hospital, or specialty facility, Understand and maximize your prescription drug benefits, Resources to support your behavioral, physical and emotional health, Exclusive programs and tools designed to help you live a healthier life, Free classes and seminars for IBX members, Convenient online resources and services for our groups, Everything you need to sell Independence Blue Cross, Find doctors, hospitals, medical equipment, and specialty services, Children's Health Insurance Program (CHIP), Critical illness, accident, and cancer insurance, Critical illness, accident and cancer insurance, Uprise Health Employee Assistance Program, Precertification and cost-share requirements, Medical policy and precertification inquiry, Provider communications email sign up form, Claims requiring submission of clinical information, Non-preferred drug: 50% up to $300 copay max, Non-preferred drug: 50% up to $200 copay max, Non-preferred drug: 50% after ded up to $500 copay max, Preferred brand: 50% after ded up to $400 copay max, Generic: $20 no deductible (integrated with medical ded), Preferred brand: 50% after ded up to $300 copay max, Non-preferred drug: 50% after ded up to $400 copay max, Generic: $25 no deductible (integrated with medical ded), Generic: 0% after deductible (integrated with medical ded). WHN's dedicated support line: 1-866-656-6071, Chiropractic Services Authorization Program Guide. Lower Premiums HMO Blue $2,000 Deductible. Member Cost with Medicare A & B Primary - This field will indicate either the amount of your annual deductible or that the deductible has been waived (forgiven) when Medicare A and B is the primary coverage. If you are using assistive technology to view web content, please ensure your settings allow for the page content to update after initial load (this is sometimes called "forms mode"). Many, but not all, members in these plans need an authorization for chiropractic services. Prescription Drugs - The amount you will pay to fill a prescription for retail brand name drugs. Your out-of-pocket maximum is $3,000per member (or $6,000per family). 1. $0 deductible for in-network medical services. . Medicare PPO Blue and members of our Federal Employee Program (FEP) are not included. HMO plan available statewide. Prescription Drugs - Mail order drug dispensing may be restricted to a specific mail order pharmacy. Dental - Does the plan cover Minor Restorative for Children (e.g., fillings, local anesthesia)? HMO: How It Works, Types, Coverage, Significance - Verywell Health that is a part of your Subscriber Certificate. Your deductible is calculated on a plan-year basis. Tier 2: $120 no deductible Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: on or after 01/01/2021 HMO Blue Basic Deductible Coverage for: Individual and Family | Plan Type: HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 155.260 to protect the privacy and security of personally identifiable information. PDF HMO Blue Basic Value - eHealth Or, go to Office Resources>Policies & Guidelines>Payment Policies. Your Deductible. Check premiums on our website at Open Enrollment at the Health Connector runs from November 1, 2022 to January 23, 2023. Have a Blue Cross Blue Shield of Massachusetts-contracted primary care provider. How quickly do customers say the plan handles claims? Blue Cross Blue Shield of Massachusetts Connector Plans
