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Medical Plans at a Glance

2023–24 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	$700 per person; $1,400 family maximum	$1,700 if you have single coverage; $3,400 if you have two-person or family coverage
Primary Care office visits	$25 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. $7,150 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 (+$80 per pay) may apply	Salary <$33,500K Single: $35.99 Two-Person: $104.02 Family: $151.10 Salary $33,500K–$70K Single: $45.22 Two-Person: $131.18 Family: $192.20 Salary $70K–$100K Single: $53.54 Two-Person: $150.77 Family: $220.75 Salary >$100K Single: $56.63 Two-Person: $160.90 Family: $233.28	Single: $15.25 Two-Person: $36.50 Family: $50.00