2012 Medical Plan Comparison Chart

 

2012 Medical Plan Options

 

BCBS Open Access POS

BCBS/HDHP Open Access POS

Benefits

In-Network

Out-of-network*

In-Network

Out-of-network*

Deductible

Single/Family

$300/$900

$400/$1,200

$1,500/$3,000

$3,000/$6,000

PCP Required

No

No

Out of Pocket Max

Single/Family

$1,000/$2,000

$2,000/$4,000

$3,000/$6,000

$6,000/$12,000

Preventive

 

 

 

 

Wellness Visit

Paid at 100%

Not Covered

Does not apply to Deductible

Paid at 100%

Paid at 70%

Subject to balance billing

Physician Services

Subject to Deductible

(except where specified)

Subject to Deductible

Office Visits

$20 co-payment

Not subject to deductible

60% of network rate

90% of network rate

70%

Lab Services (X-rays)

90% of network rate

60% of network rate

90% of network rate

70%

Maternity Care

90% of network rate after initial copay

60% of network rate

90% of network rate

70%

Inpatient Hospital

Subject to Deductible & Precertification

Hospital Services

90% of network

60% of network

90% of network

70% of network

Outpatient Hospital

Subject to Deductible

Outpatient Surgery

90% of network

60% of network

90% of network rate

70%

Emergency Room

$75 co-pay, then 90% of network rate

$75 co-pay, then 90% of network rate

90% of network rate

70%

Pharmacy

 

 

Generic

$10 co-payment

90% of lower discounted rate or actual charge

90%

Brand Name

$30 co-payment for Preferred Brand;

20% copayment for Non-Preferred Brand

Retiree Coverage

Yes

Yes 

 

*Out-of-Network subject to balance billing

This comparison chart was prepared for summary purposes only and only highlights the major differences between the plans. For a complete plan comparison, please review the Plan document available through the BCBS website at www.bcbsga.com/bor