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MEDICAL

PLAN OVERVIEW

Mary Free Bed is proud to offer services to our employees within our facilities. The plan overviews below outline how much you will pay out of pocket for services administered by Mary Free Bed and designated providers, as well as other in-network providers. 

Plan 1
BCBSM HDHP PPO
Member's Responsibility

  MARY FREE BED & DESIGNATED PROVIDERS
OTHER IN-NETWORK PROVIDERS
Annual deductible (individual/family) $1,700/$3,400
$2,000/$4,000
Deductible Type Aggregate
Aggregate
Coinsurance 10%
20%
Annual Out-of-Pocket Maximum
(individual/family)
$2,500/$5,000
$5,000/$10,000
Preventative & Wellness Care Covered 100%
Covered 100%
Virtual Visit 20% after deductible
20% after deductible
Primary Care Office Visit 0% after deductible
20% after deductible
Specialist Visit 0% after deductible
20% after deductible
Urgent Care Visit 20% after deductible
20% after deductible
EMPLOYEE BI-WEEKLY CONTRIBUTIONS
  FTE 0.75-1.0 PTE 0.5-.0.74
  Mary & Me
Participant
Non-Mary & Me
Participant
Mary & Me
Participant
Non-Mary & Me 
Participant
Employee Only        
Employee + Spouse        
Employee + Child(ren)        
Employee + Family        

Plan 2
BCBSM PPO
Member's Responsibility

  MARY FREE BED & DESIGNATED PROVIDERS
OTHER IN-NETWORK PROVIDERS
Annual deductible (individual/family) $500/$1,000 $1,000/$2,000
Deductible Type Embedded Embedded
Coinsurance 10%
20%
Annual Out-of-Pocket Maximum
(individual/family)
$2,500/$5,000
$6,350/$12,700
Preventative & Wellness Care Covered 100%
Covered 100%
Virtual Visit $25 copay $25 copay
Primary Care Office Visit $25 copay $25 copay
Specialist Visit $40 copay $40 copay
Urgent Care Visit $75 copay $75 copay
EMPLOYEE BI-WEEKLY CONTRIBUTIONS
  FTE 0.75-1.0 PTE 0.5-.0.74
  Mary & Me
Participant
Non-Mary & Me
Participant
Mary & Me
Participant
Non-Mary & Me 
Participant
Employee Only        
Employee + Spouse        
Employee + Child(ren)        
Employee + Family        

A preferred provider organization (PPO) is a health plan that has contracts with a network of preferred providers from which you can choose. With a PPO plan, you have the flexibility of visiting “in-network" or “out-of-network" providers. However, utilizing in-network providers is a much cheaper option than that of out-of-network providers. You do not need to select a primary care physician (PCP) and you do not need referrals to see a specialist.

SUMMARY OF BENEFITS AND COVERAGE (SBC)
Outlines what's covered and what's not under your plan.
NOTE: Mental health, substance use, and autism benefits are offered through Telus Health. See the Resources > EAP tab to learn more.

Plan 1: BCBSM HDHP PPO

Benefits summary for the BCBSM HDHP PPO plan, providing an easy-to-read overview of your benefits.

Download

Plan 2: BCBSM PPO

Benefits summary for the BCBSM PPO plan, providing an easy-to-read overview of your benefits.

Download

BENEFITS-AT-A-GLANCE (BAAG)
Contains easy-to-read benefits summary.
NOTE: Mental health, substance use, and autism benefits are offered through Telus Health. See the Resources > EAP tab to learn more.

Plan 1: BCBSM HDHP PPO

Benefits summary for the BCBSM HDHP PPO plan, showing what the plan covers and what you will pay out-of-pocket.

Download

Plan 2: BCBSM PPO

Benefits summary for the BCBSM PPO plan, showing what the plan covers and what you will pay out-of-pocket.

Download