Summary of Benefits and Coverage. Prescription Search . 0000034618 00000 n Summary of Benefits and Coverage. 0000010298 00000 n >> /SMask /None BlueChoice Advantage HSA/HRA Combined Rx Summary of Plan Options; Options Features Medical Summary Rx Summary; Option 1: In: $1,400 Ded. An HRA reimburses employees and their families for eligible medical expenses. There are open access plans through BlueChoice Advantage and BlueChoice Advantage Plus, which allows members to visit doctors and specialists without a referral. endobj /Type /Catalog BlueChoice Advantage HSA/HRA Bronze 6000. >> 0000002923 00000 n • BlueChoice Advantage HSA/HRA Silver 3000 • BlueChoice Advantage Silver 5000 : Gold • BlueChoice Advantage HSA/HRA Gold 1500 • BlueChoice HMO Gold 1500 • BlueChoice Advantage Gold 1000 . Regional BlueChoice … /AIS false trailer /Outlines 14 0 R Summary of Benefits and Coverage. /Resources << >> 54 0 R If you want more detail about your coverage and … BlueChoice Advantage HSA/HRA Bronze 6100. Your cost for certain benefits is 10% coinsurance. /Font << bluechoice open access point of service evidence of coverage important notice covered benefits received from an out-of-network provider, except in certain circumstances (see section 5.0. Deductible: Individual/Family. /LastChar 121 44 0 R BlueChoice Advantage HRA (Non-Integrated) Summary of Benefits. H���Oo�0��| /T 116678 0 593 556 0 0 0 0 0 0 0 0000003642 00000 n 0000002063 00000 n Oral Chemo Drugs and Diabetic Supplies HSA - No charge* after deductible; HRA - No charge* Generic Drugs Deductible, then 30-day supply $10; Deductible, then 90-day supply $20 (maintenance drugs only) Preferred Brand Drugs11 Deductible, then 30-day supply $45; Deductible, then 90-day supply $90 (maintenance drugs only) Non-preferred Brand Drugs12 Deductible, then 30-day supply $65; … Summary of Benefits and Coverage. BlueChoice Advantage HRA/HSA Integrated Deductible SUM1680-1P (12/15) n DC n 2-50, 51-199, 200+ Option 1 . There are also high deductible health plans (HDHPs) and flexible spending accounts (FSAs), and health reimbursement accounts (HRAs) for some health plan members. >> ��C1\dR�Te�Ry��/R�쏰�^U��ێi�TY�MZ��.���N��X"�),t��o�d:x�Z��ʧ#�O6K\�ku�ג[�mF���D /Type /ExtGState MENTAL HEALTH AND SUBSTANCE USE DISORDER—(Members are responsible for both physician and facility fees) Office Visits Deductible, then $10 per visit Deductible, then $40 per visit Outpatient Services Plus, individuals can typically use HRA funds to pay for deductibles, co-insurance, co-payments, and prescriptions, among other out-of-pocket healthcare expenses, depending on HRA plan details. /Prev 116667 Out-Network: $3,000 / $6,000, In-Network: $500 / $1,000 Contract. %PDF-1.4 If you want more detail about your coverage and … 0000003366 00000 n /OPM 1 /SMask /None BlueChoice Advantage HSA/HRA Gold 1500 Summary of Benefits. 0000013557 00000 n /BM /Normal /Contents [ 26 0 R Headquartered in Salt lake City, Utah - The HRA Group is a division of HR Advantages, a privately held company providing Contract Staffing Services. BlueChoice service area, when covered services are rendered by a provider in the preferred provider network, care is also covered at the in-network level. 100%-70% In-Range—no changes . delta Silver: Nationwide In-Network. Out-Network: $3,000 / $6,000 /Widths [ 537 278 0 0 0 0 0 0 0 0 Summary of Benefits and Coverage. BlueChoice Advantage HSA/HRA Bronze 6000. These in-network These in-network benefits are based on the contracted rates or fee schedules that preferred providers have agreed to accept as payment for covered services that are established by the local Blue BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. 0000015942 00000 n ��Fb��f��q��}?�U�pc[��V-�v8ld�����R�h��'�1�jP��-����_OPh��j0!$�R. >> /T1_4 31 0 R /AIS false It has a deductible of $5,500 and an out-of-pocket maximum of $7,150. /BaseFont /IQWVHN+AvenirLTStd-Book CareFirst does not exclude people or … /CA 1 CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc., CareFirst Diversified Benefits and all of their corporate affiliates (CareFirst) comply with applicable federal civil rights laws and do not discriminate on the . 0000024839 00000 n 0000009533 00000 n 100%-70% SUM1679: Integrated Rx … BlueChoice HMO Referral Silver 4000. Out-Network: $1,000 / $2,000, In-Network: $1,000 / $2,000 Out-Network: $1,000 / $2,000. A health reimbursement arrangement (HRA) is an account that your employer owns and deposits a predetermined amount into each year for qualified health care expenses, such as copays, flat doctor or specialist fees and medical supplies. BlueChoice Advantage HSA/HRA Silver 1500 Coverage Period: 01/01/2019 - 12/31/2019 Coverage for: Individual | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Services In-Network You Pay. • 2021 benefit summaries will be posted on the broker portal soon. My Health Toolkit Access your digital ID card, check claims status, view plan details, and check your benefits. /O 21 �xW4!E�R|*��R�y�I��I�"�y��Ǚ�їxH�� 0 0000009166 00000 n BlueChoice HMO HSA/HRA $2,000 BlueChoice HMO Referral HSA/HRA $4,000-SE BlueChoice HMO HSA/HRA $3,000 BlueChoice HMO Referral $30/$40 BlueChoice HMO $1,000-SE BlueChoice … endobj << /SA true /Length 831 /Type /XRef BlueChoice Advantage Gold 3000. 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