/ Human Resources

Medical Plans at a Glance

2021/22 in-network Plans

  Blue (Traditional) Plan Orange (HDHP) Plan
Preventive Care (per BCBSM Guidelines) 100% coverage. Not subject to deductible. 100% coverage. Not subject to deductible.
Deductible $600 per person; $1,200 family maximum $1,600 if you have single coverage; $3200 if you have two-person or family coverage
Primary Care office visits $20 copay. Not subject to deductible. 80% coverage after deductible is met.
online office visits $10 copay. Not subject to deductible. $49 fee until deductible met, then 80% coverage.
urgent care and Specialist Office Visits $50 copay. Not subject to deductible. 80% coverage after deductible is met.
Ambulance $50 copay. Not subject to deductible. 80% coverage after deductible is met.
 Emergency room visits $250 copay. Not subject to deductible 80% coverage after deductible is met.
Most other covered services (see Benefits at a Glance below for exceptions of services covered at lower percent) 80% coverage after deductible is met. 80% coverage after deductible is met.
Annual out-of-pocket maximum $3,000 per person; $6,000 family maximum $4,000 if you have single coverage. $7,000 if you have two-person or family coverage.
auto accident exclusion (benefits are not payable under the plan for injuries received in a accident involving a motor vehicle)
FOR MORE INFO REVIEW:  FAQ

Yes, applicable.

Yes, applicable.

 Benefits at a glance Blue BAAG Orange BAAG
Summary of Benefits and Coverage: Blue SOB&C  Orange SOB&C 
Employee premiums (per pay period, two times/month)

*additional spouse surcharge (+$75 per pay) may apply
Salary <$33,500K
Single: $35.64
Two-Person*: $100.98
Family*: $141.09

Salary $33,500K-$70K
Single: $43.47
Two-Person*: $122.48
Family*: $171.12

Salary $70K–$100K

Single: $49.99
Two-Person*: $136.80
Family*: $191.13

Salary >$100K
Single: $51.39
Two-Person*: $140.65
Family*: $196.49
Single: $13.75
Two-Person*: $31.00
Family*: $41.25