BlueCard PPO

• Two types of coverage in one plan
  • Managed Care
  • 70/30 Traditional Plan
• No Designated Primary Care Physician
• No Referrals Required for Specialized Treatment
• Nationwide Office Coverage
• $5.00 Co-payment
• Prescription Plan
  ($10 Generic/$15 Name Brand)
• Vision Coverage
• Higher Monthly Employee Contribution

HMO Blue

• Managed Care
• Primary Care Physician
• Primary Care Physician directional system using referrals for specialized care
• Nationwide Emergency Room Coverage
• $10.00 Co-payment
• Prescription Plan
  ($10 Generic/ $15 Name Brand)
• Vision Coverage
• Lower Monthly Employee Contribution

Managed Dental Choice

• Primary Care Dentist
• $5,00 Co-Payment*
• 100% Coverage on Preventative Service
  
  • Office Visit
  • Cleaning & X-Rays
• 100% coverage on Basic Service*
  • Fillings
  • Extractions, Root Canal
  • Certain Procedures
• 50% Coverage on Major Service*
• Lower Monthly Employee Contribution
• No dollar limit of coverage per person per year

Traditional

• No Designated Dentist
• 80/20 Traditional Plan
• $50.00 per person per year deductible/ $150 for family 3 persons and above
• 100% Coverage on preventative Service - Deductible Waived
• 80% Coverage on Basic Services - After Deductible
• No Coverage on Major Services
• $1,000.00 limit per person per year
• Higher Monthly Employee Contribution