Health Insurance Benefits Changes
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Benefit Changes
The Following Services Are No Longer Covered.
- Routine Eye Exams
- Infertility Treatment
- Massage Therapy
- Brooks weight loss program
- Self –Administered Injectable Prescription Drugs will now require a $55.00 Copay for each 30 day supply.
- Network Blue Providers are the only in-Network Providers.
- The timeframe for which an initial appeal of an Adverse Benefit Determination must be submitted in writing to BCBSF has changed from 365 days to 90 days.
New Cost Share Provisions.
Deductable In-Network |
$300.00 Individual, $600.00 Family |
Deductable Out-of-Network |
$500.00 Individual, $1000.00 Family |
Out of Pocket Maximums in Network |
$2500.00 Individual, $5000 Family |
Out of Pocket Maximums out of Network |
$3250.00 individual, $6500 Family |
Hospitalization in Network |
80% |
Hospitalization Out of Network |
50% |
Emergency Room in Network |
$250.00 |
Primary Care Physician in Network |
$10.00 |
Specialist in Network |
$35.00 |
Generic drugs |
$7.00 |
Brand Name drugs |
$30.00 |
Non-Formulary |
$55.00 |
Self Administered Injectable drugs |
$55.00 |
