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Medical

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        

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

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Plan 2: BCBSM PPO

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