Health Insurance Plan Comparison

Cost Sharing - Member's Responsibility

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
Deductible (DED) (Per Person/Family Aggregate)
In-NetworkN/A$500 / $1,500$1,500 / NA$3,000 / $3,000
Out-of-NetworkN/ACombined w/ INN$3,000 / NA$6,000 / $6,000
Coinsurance (BCBSF pays / Member pays)
In-NetworkN/A80% / 20%80% / 20%80% / 20%
Out-of-NetworkN/A70% / 30%60% / 40%60% / 40%
Out of Pocket Maximum (Per Person/Family Aggregate)
In-NetworkIncludes Pharmacy - $5,000 / $10,000Includes Pharmacy - $5,000 / $10,000$4,500 / NA$6,850 / $9,000
Out-of-NetworkIncludes Pharmacy - N/AIncludes Pharmacy - Combined w/ INN$9,000 / NA$18,000 / $18,000

Medical / Surgical Care by a Physician

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
Office Services
In-Network Family Physician$25$25DED + 20%DED + 20%
In-Network Specialist$40$40DED + 20%DED + 20%
Out-of-NetworkNot CoveredDED + 30%DED + 40%DED + 40%
Physician Services at Hospital
In-Network$0DED + 20%DED + 20%DED + 20%
Out-of-NetworkNot CoveredDED + 30%INN DED + 20%INN DED + 20%

Medical / Surgical Care at a Facility

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
Inpatient Hospital Facility (per admit)
In-Network$150 per day up to $750 per admissionOption 1: $750
Option 2: $1,500
Option 1: Ded + 20%
Option 2: Ded + 25%
Option 1: Ded + 20%
Option 2: Ded + 25%
Out-of-NetworkNot Covered$2500$500 PAD + DED + 40%$500 PAD + DED + 40%
Outpatient Hospital Facility (per visit) (Surgical)
In-Network$200Option 1: $150
Option 2: $250
Option 1: Ded + 20%
Option 2: Ded + 25%
Option 1: Ded + 20%
Option 2: Ded + 25%
Out-of-NetworkNot Covered$350DED + 40%DED + 40%
Outpatient Hospital Facility (per visit) (Non-Surgical)
In-Network$0Included with Surgical ServicesOption 1: Ded + 20%
Option 2: Ded + 25%
Option 1: Ded + 20%
Option 2: Ded + 25%
Out-of-NetworkNot CoveredIncluded with Surgical ServicesDED + 40%DED + 40%

Emergency and Urgent Care

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
Emergency Room Facility (per visit) - If admitted as an inpatient from ER, the hospital will submit an inpatient hospital claim instead of an ER facility claim. ER Copay will not apply on the claim; only inpatient facility cost share will apply.
In-Network$50$100 + 20%Ded + 20%Ded + 20%
Out-of-Network$50$100 + 30%INN DED + 20%INN DED + 20%
Urgent Care Centers
In-Network$35$35DED + 20%DED + 20%
Ambulance
In-Network$0DED + 20%DED + 20%DED + 20%
Out-of-Network$0INN DED + 20%INN DED + 20%INN DED + 20%

Other Special Services

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
Gastric Bypass
1 PBP1 PBP1 PBP1 PBP
TeleMedicine Services
$10$10DED + Coin, Allowance Maximum $45DED + Coin, Allowance Maximum $45

Prescription Drugs

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
In-Network - Generic / Brand / Non-Preferred
Retail$15 / $45 / $65$15 / $45 / $65DEDDED
Mail Order$30 / $90 / $130$30 / $90 / $130DEDDED

Monthly premiums

HMO
BlueCare 10
BlueOptions 3766Blue Options HSA 05190 Individual Plan
Account Funding: EE Only=$500
Blue Options HSA 05191 Family Plan
Account Funding: EE+1=$1,000 or EE+2=$1,500
Partially Health Care Reform Compliant (Grandfathered)Partially Health Care Reform Compliant (Grandfathered)Health Care Reform CompliantHealth Care Reform Compliant
Employee (College paid)
$864$683$395$395
Employee + 1
$864$683$345$345
Employee + Family
$1422$794$360$360