BlueEssentials offers affordable nationwide health-care
coverage. As the introductory program in the BlueChoices
suite, BlueEssentials is the most cost-effective solution
to providing comprehensive coverage. Offering the highest
deductibles of the BlueChoices suite, it promotes cost-sharing
between employer and employee through one or more employee
spending accounts, encouraging employees to make
financially wise health-care choices. BlueEssentials
is ideally suited to companies not currently offering
health-care coverage or to employers seeking rate relief.
In most cases a deductible and/or coinsurance apply
instead of a copayment.
The snapshot below provides only a partial summary
of benefits. Refer to the Benefits Booklet for a complete
description of benefits, exclusions and limitations.
BlueEssentialsSM |
| |
In-network |
Out-of-network |
| Lifetime Maximum |
$2,000,000
|
Provider Networks
- With Access, out-of-network providers can
bill members for uncovered balances
- With Participating, out-of-network providers
will be paid at our allowable amount, not billed
charges
|
Participating
Preferred Provider Plan
Access |
Deductible
|
$500
$1,000 (HRA available for groups of 51+)
$2,000 (HRA available for groups of 51+) |
| Coinsurance |
70% |
50% |
Maximum Coinsurance
Must meet separate maximum coinsurance amount for
out-of-network – not a combination of the
in- and out-of-network
|
$3,000 |
$10,000 |
| Family Deductible |
Three individual
family members must meet the deductible (no family
aggregate) |
Preventive
Services |
Annual Women’s Exam
Includes pap and mammogram
|
$20 copay |
Deductible and coinsurance
apply |
Immunizations
Adult and children
|
$10 copay |
$10 copay |
Well Baby Care
To age 2 |
$20 copay |
Deductible and coinsurance
apply |
| Routine Health Exams |
- $20 copay
- $200 limit, includes DRL
|
Not covered |
| Professional
Services – copays and deductible waiver
apply to in-network only; out-of-network subject
to deductible and coinsurance |
Office Visit
- With immunization, additional $10 copay collected
- If more than one office visit per day, applicable
copay collected for each visit
|
- Personal physician: $20 copay
- Specialist: $40 copay
- Above copays for office visits only
- All other office services subject to deductible
and coinsurance
|
Deductible and coinsurance
apply |
Outpatient DRL (Diagnostic Radiology & Lab)
- Includes DRL in an outpatient setting, such
as an emergency room
- Does not apply to preventive services
|
Deductible and
coinsurance apply |
| Maternity |
Deductible and
coinsurance apply |
| Urgent Care Professionals |
Deductible and
coinsurance apply |
| Facility
Benefits |
Inpatient/Residential Facility Care
- Surgery and related services
- Related services and supplies
- Maternity care
- Skilled nursing facility (SNF)
- Inpatient rehabilitation
|
- Deductible and coinsurance apply
- Payment is limited to semi-private room rate
- SNF is limited to 14 days. If authorized
by health plan the benefit may be increased
to 100 days.
|
Outpatient Facility Care
Surgery and Related Services
|
Deductible and
coinsurance apply |
Emergency Room
- Copay waived if admitted to the hospital
- If true emergency, regardless of location,
the in-network benefit applies for facility
and professional. If hospitalized, out-of-network
benefit applies.
- For Preferred Provider Plan and Preferred
Care Network, out-of-network benefit and hold
harmless apply for true emergency.
|
$100 copay, deductible
and coinsurance apply |
| Miscellaneous
Benefits |
- Hospice services
- Durable medical equipment and supplies, prosthetic
and orthotic devices
- Outpatient and listed in facility rehabilitation
services
|
Deductible and
coinsurance apply |
Chemical Dependency/Mental Health |
-
Oregon mandates apply
-
In-network: Personal Physician $20 copay / Specialist $40 copay; Out-of-Network: deductible and coinsurance
-
Above copays for office visits only
-
All other services subject to deductible and coinsurance
-
45-day limit per calendar year for mental health residential treatment
|
Special Beginnings®
Prenatal Education Program
|
Included |
BlueCard® Program
Nationwide coverage through the one-of-its-kind
program |
Included |
Accidental Death
|
$25,000 per employee
and enrolled spouse; $5,000 per enrolled dependent
child |
