Community Preferred

(formerly offered through BRS)

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2013 Community Preferred Benefit Summaries
  

 

Vermont Freedom Plans (PPO)

with vision exam

• $750/$1,500 deductible - 80%/20% co-insurance to $3,750/$7,500 out-of-pocket limit

• $1,500/$3,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

• $2,500/$5,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

• $5,000/$10,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

• $10,000/$20,000 deductible - out-of-pocket limit equals annual deductible

with vision exam and materials

• $750/$1,500 deductible - 80%/20% co-insurance to $3,750/$7,500 out-of-pocket limit

• $1,500/$3,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

• $2,500/$5,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

• $5,000/$10,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

• $10,000/$20,000 deductible - out-of-pocket limit equals annual deductible

 

Blue CDHP (Comprehensive) with Wellness Drug Benefits-HSA/HRA Compatible

with vision exam

• $2,250/$4,500 deductible (aggregate*) - 80%/20% co-insurance to $3,250/$6,500 out-of-pocket limit

• $4,000/$8,000 deductible (aggregate*) - 80%/20% co-insurance to $5,000/$10,000 out-of-pocket limit

with vision exam and materials

• $2,250/$4,500 deductible (aggregate*) - 80%/20% co-insurance to $3,250/$6,500 out-of-pocket limit

• $4,000/$8,000 deductible (aggregate*) - 80%/20% co-insurance to $5,000/$10,000 out-of-pocket limit
  

BlueCare CDHP (HMO)** with Wellness Drug Benefits - HSA/HRA Compatible

with vision exam

• $2,000/$4,000 deductible (aggregate*) - 100% coverage after deductible

• $2,500/$5,000 deductible (aggregate*) - 100% coverage after deductible

• $2,500/$5,000 deductible (aggregate*) - 80%/20% co-insurance to $5,950/$11,900 out-of-pocket limit.

• $3,000/$6,000 deductible (stacked^) - 100% coverage after deductible

• $5,000/$10,000 deductible (stacked^) - 100% coverage after deductible

with vision exam and materials

• $2,000/$4,000 deductible (aggregate*) - 100% coverage after deductible

• $2,500/$5,000 deductible (aggregate*) - 100% coverage after deductible

• $2,500/$5,000 deductible (aggregate*) - 80%/20% co-insurance to $5,950/$11,900 out-of-pocket limit.

• $3,000/$6,000 deductible (stacked^) - 100% coverage after deductible

• $5,000/$10,000 deductible (stacked^) - 100% coverage after deductible
  
  

BlueCare Access CDHP (HMO) ** ^^ with Wellness Drug Benefits- HSA/HRA Compatible

with vision exam

• $2,000/$4,000 deductible (aggregate*) - 80%/20% co-insurance to $3,000/$6,000 out-of-pocket limit

• $3,000/$6,000 deductible (stacked^) - 80%/20% co-insurance to $4,000/$8,000 out-of-pocket limit

with vision and materials

• $2,000/$4,000 deductible (aggregate*) - 80%/20% co-insurance to $3,000/$6,000 out-of-pocket limit

• $3,000/$6,000 deductible (stacked^) - 80%/20% co-insurance to $4,000/$8,000 out-of-pocket limit

BlueCare (HMO) **

with vision exam

• Plan D: $500 inpatient co-pay and $200 outpatient co-pay

• Plan I: $1,000 inpatient/outpatient combined deductible

• Plan K: $2,000 inpatient deductible and $1,000 outpatient deductible

with vision exam and materials

• Plan D: $500 inpatient co-pay and $200 outpatient co-pay

• Plan I: $1,000 inpatient/outpatient combined deductible

• Plan K: $2,000 inpatient deductible and $1,000 outpatient deductible

BlueCare Access (HMO) ** ^^

with vision exam

• $1,500 inpatient deductible and $750 outpatient deductible

with vision exam and materials

• $1,500 inpatient deductible and $750 outpatient deductible

 

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Plans with the grandfathered prescription drug benefit for current members:

$100 deductible, $5 copayment for generic, $25 copayment for preferred brand, and $50 copayment for non-preferred brand

 

Vermont Freedom Plans (PPO)

with vision exam

• GF-$750/$1,500 deductible - 80%/20% co-insurance to $3,750/$7,500 out-of-pocket limit

• GF-$1,500/$3,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

with vision exam and materials

• GF-$750/$1,500 deductible - 80%/20% co-insurance to $3,750/$7,500 out-of-pocket limit

• GF-$1,500/$3,000 deductible - 80%/20% co-insurance to $7,500/$15,000 out-of-pocket limit

BlueCare (HMO) **

with vision exam

• GF- Plan D: $500 inpatient co-pay and $200 outpatient co-pay

• GF- Plan I: $1,000 inpatient/outpatient combined deductible

• GF- Plan J: $1,500 inpatient deductible and $750 outpatient deductible

• GF- Plan K: $2,000 inpatient deductible and $1,000 outpatient deductible

with vision exam and materials

• GF- Plan D: $500 inpatient co-pay and $200 outpatient co-pay

• GF- Plan I: $1,000 inpatient/outpatient combined deductible

• GF- Plan J: $1,500 inpatient deductible and $750 outpatient deductible

• GF- Plan K: $2,000 inpatient deductible and $1,000 outpatient deductible

 

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CDHP – Consumer-Directed Health Plan

 

*  Aggregate Deductible: Full single or entire family deductible must be satisfied before benefits are paid.

 

^  Stacked Deductible: Plan pays for an individual once the individual deductible is met.

 

** If you are choosing a BlueCare plan for the first time, each subscriber must complete a new enrollment form and select a Primary Care Physician (PCP) for each member.

 

^^ BlueCare Access allows for up to 40% of subscribers to live outside of the BlueCare Access Service Area.