Enrollees who wish to cover one eligible family member are free to elect either the Self and Family or Self Plus One enrollment type. NOTE: HDHP plans require that the combined medical and pharmacy deductible be met beforeĭisclaimer: In some cases, the enrollee share of premiums for the Self Plus One enrollment type will be higher than for the Self and Family enrollment type. When a “yes” appears indicating that there is coverage for a specific service, you mustĬheck the plan brochure for your cost share. Plan’s allowance and the provider’s billed amount. When you see a plus sign (+), it means you must pay the stated coinsurance AND any difference between your Even though you pay a premium for Part B and your Service Beneft Plan coverage, when you combine them, we eliminate your other out-of-pocket costs (deductibles, copays and coinsurance) for covered medical services. The amounts shown below indicate what you will pay for each class of service. Before making your final enrollment decision,Īlways refer to the individual FEHB brochure which is the official statement of benefits. Premera Blue Cross Blue Shield of Alaska is an Independent Licensee of the Blue Cross Blue Shield. The information contained in this comparison tool is not the official statement of benefits. Preferred specialty drugs 100 copay/prescription. Multi-State Plan Program Toggle submenu.Flexible Spending Accounts Toggle submenu.Changes in Health Coverage Toggle submenu.Urgent care, 8 a.m.–8 p.m., M–F and 10 a.m.– 4 p.m., Saturdays and Sundays (holiday hours may vary).Medical specialty services such as allergy, dermatology.All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005 FEP Blue Focus: RI 71-017). Service for employees at MIT Medical include: This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan.
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