Plans Tailored For Your Business.

2022 Health Plans    |    2022 Dental Blue Plans    |    2022 Vision BlueSM Plans

 

 
Represents In-Network Benefits
Reset Plans
 

Blue
Choice®
Platinum for Business


 

Blue
Access® Gold
for Business


 

Blue
Secure Gold
for Business


 

Blue
Secure Silver
for Business


 

Blue
HSA Silver
for Business


 

Blue
Saver® Bronze
for Business

Materials

View Coverage Summary (SBC)

View Benefit Summary

View Benefit Booklet

Get Quote
 

View Coverage Summary (SBC)

View Benefit Summary

View Benefit Booklet

Get Quote
 

View Coverage Summary (SBC)

View Benefit Summary

View Benefit Booklet

Get Quote
 

View Coverage Summary (SBC)

View Benefit Summary

View Benefit Booklet

Get Quote
 

View Coverage Summary (SBC)

View Benefit Summary

View Benefit Booklet

Get Quote
 

View Coverage Summary (SBC)

View Benefit Summary

View Benefit Booklet

Get Quote
 
Calendar Year Deductible

SELF-ONLY

FAMILY

 

$100

$200

 

$600

$1,200

 

$1,200

$2,400

 

$4,000

$8,000

 

$4,000

$8,000

 

$7,850

$15,700

Out-of-Pocket

SELF-ONLY

FAMILY

  Includes deductible, copays, and coinsurance for
in-network services
  MORE
 

$4,000

$8,000

 

$6,000

$12,000

 

$6,750

$13,000

 

$8,550

$17,100

 

$6,000

$12,000

 

$7,850

$15,700

Office Visit Copay

$20 Primary Care/
$30 Specialist

$30 Primary Care/
$50 Specialist

$35 Primary Care/
$60 Specialist

$40 Primary Care/
$70 Specialist

Plan pays 80% after Deductible

$40 copay for 1st three illness related office visits; thereafter plan pays 100% after Deductible

Telephone and Online Video Consultation
Available through Teladoc

$20 payment per consultation

$30 payment per consultation

$35 payment per consultation

$40 payment per consultation

Plan pays 0% after a $55 payment per consultation

$45 payment per consultation

Inpatient
Hospital

Plan pays 100% after $150 daily copay days 1 - 5 for each admission

Lower Member
Cost Share:

Plan pays 100% after $250 daily copay days 1-5 for each admission

Higher Member
Cost Share:

Plan pays 100% after $500 daily copay days 1-5 for each admission

Lower Member
Cost Share:

Plan pays 100% after $300 daily copay days 1-5 for each admission

Higher Member
Cost Share:

Plan pays 100% after $600 daily copay days 1-5 for each admission

Lower Member
Cost Share:

Plan pays 100% after $450 daily copay days 1-5 for each admission

Higher Member
Cost Share:

Plan pays 100% after $850 daily copay days 1-5 for each admission

Plan pays 80%
after Deductible

Plan pays 100%
after Deductible

Outpatient
Surgery

Plan pays 100% after $150 hospital copay

Lower Member
Cost Share:

Plan pays 100% after $250 hospital copay

Higher Member
Cost Share:

Plan pays 100% after $500 hospital copay

Lower Member
Cost Share:

Plan pays 100% after $300 hospital copay

Higher Member
Cost Share:

Plan pays 100% after $600 hospital copay

Lower Member
Cost Share:

Plan pays 100% after $450 hospital copay

Higher Member
Cost Share:

Plan pays 100% after $850 hospital copay

Plan pays 80%
after Deductible

Plan pays 100%
after Deductible

ER Visit

Plan pays 100% after $150 hospital copay

Plan pays 100% after $250 hospital copay

Plan pays 100% after $300 hospital copay

Plan pays 100% after $450 hospital copay

Plan pays 80%
after Deductible

Plan pays 100%
after Deductible

Prescription Drugs (per 30-day supply)
Tier 1
$10 copay

Tier 2
$20 copay

Tier 3
$35 copay

Tier 4
$75 copay

Tier 5
$100 copay

Tier 6
$200 copay

Tier 1
$10 copay

Tier 2
$20 copay

Tier 3
$40 copay

Tier 4
$80 copay

Tier 5
$125 copay

Tier 6
$250 copay

Tier 1
$10 copay

Tier 2
$20 copay

Tier 3
$50 copay

Tier 4
$90 copay

Tier 5
$200 copay

Tier 6
$300 copay

Tier 1
$15 copay

Tier 2
$30 copay

Tier 3
$75 copay

Tier 4
$100 copay

Tier 5
$250 copay

Tier 6
Plan pays 60%

Tier 1 - Tier 6
Plan pays 80%
after Deductible

 

Tier 1
$20 copay

Tier 2
$35 copay

Tier 3 - Tier 6
Plan pays 100% after Deductible

*Covered Insulin Cost Share Cap - A maximum $99 cost share will be implemented for covered insulin products for each 30-day supply. For HSA-Qualified HDHPs when a covered insulin product qualifies as preventative care, the cost share cap applies whether or not deductible has been met. When a covered insulin product does not qualify as preventative care, the cost share cap shall not apply until deductible has been met.
Mail Order Pharmacy
(90 day supply)

Tier 1
$25 copay
Tier 2
$50 copay

Tier 3
$87.50 copay

Tier 4
$187.50 copay

Tier 5
not covered

Tier 6
not covered

Tier 1
$25 copay
Tier 2
$50 copay

Tier 3
$100 copay

Tier 4
$200 copay

Tier 5
not covered

Tier 6
not covered

Tier 1
$25 copay
Tier 2
$50 copay

Tier 3
$125 copay

Tier 4
$225 copay

Tier 5
not covered

Tier 6
not covered

Tier 1
$37.50 copay
Tier 2
$75 copay

Tier 3
$187.50 copay

Tier 4
$250 copay

Tier 5
not covered

Tier 6
not covered

N/A

N/A

*Covered Insulin Cost Share Cap - A maximum $99 cost share will be implemented for covered insulin products for each 30-day supply.
ValueONE Pharmacy Network

x

x

x

x

x

x

Source+Rx 2.0 Formulary

x

x

x

 

 

 

Source+Rx 1.0 formulary

 

 

 

x

x

x

Pediatric Vision

Plan pays 80%
after Deductible

Plan pays 80%
after Deductible

Plan pays 80%
after Deductible

Plan pays 80%
after Deductible

Plan pays 80%
after Deductible

Plan pays 100%
after Deductible

Pediatric Dental

DIAGNOSTIC & PREVENTIVE

BASIC SERVICES

MAJOR SERVICES

MEDICALLY NECESSARY ORTHODONTIA

 

Plan pays 100%

 

Plan pays 80%

 

Plan pays 50%
after Deductible

Plan pays 50%
after Deductible

 

Plan pays 100%

 

Plan pays 80%

 

Plan pays 50%
after Deductible

Plan pays 50%
after Deductible

 

Plan pays 100%

 

Plan pays 80%

 

Plan pays 50%
after Deductible

Plan pays 50%
after Deductible

 

Plan pays 100%

 

Plan pays 80%

 

Plan pays 50%
after Deductible

Plan pays 50%
after Deductible

 

Plan pays 100%
after Deductible

Plan pays 80%
after Deductible

Plan pays 50%
after Deductible

Plan pays 50%
after Deductible

 

Plan pays 100%

 

Plan pays 100%

 

Plan pays 100%
after Deductible

Plan pays 100%
after Deductible