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Note: The benefit spreadsheet below reflects "In-Network" benefits payable to participating doctors / hospitals. The intention of the spreadsheet is to point out general differences between the health insurance carriers. This is not a sales brochure or a official brochure from the carriers. It is simply an interpretation of benefits payable by carrier. THEREFORE for details please download the official brochure and application kit from the carrier of your choice.

Benefits BlueBasic
Copays
 		 BlueAdvantage
Copays  		 BlueBasic
Catastrophic 

BlueAdvantage Catastrophic
         
Office Visit Copay

$30

$20

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
Calendar Yr. Ded.


Max Family Deductible----->

 

You Choose Your Deductible of
250, 500 or 1,000

250 x 3
500 x 2
1000 x 2

You Choose Your Deductible of
250, 500 or 1,000

250 x 3
500 x 2
1000 x 2

 You Choose Your Deductible of 2500, 5000, 7500

2500 x 3
5000 x 2
7500 x 2

You Choose Your Deductible of 2500, 5000, 7500

2500 x 3
5000 x 2
7500 x 2
         
Out of Pocket Max.

Single---->
 


Family---->


Single
250 deductible = 3000
500 deductible = 4000
1000 deductible = 5000

Family
250 deductible = 6000
500 deductible = 8000
1000 deductible = 10000


Single
250 deductible = 2500
500 deductible = 3000
1000 deductible = 3500

Family
250 deductible = 5000
500 deductible = 6000
1000 deductible = 7000 


Single
2500 deductible = 6000
5000 deductible = 7000
7500 deductible = 10000

Family
2500 deductible = 11000
5000 deductible = 13000
7500 deductible = 18000 

 


Single
2500 deductible = 4000
5000 deductible = 6500
7500 deductible = 9000

Family
2500 deductible = 8000
5000 deductible = 12000
7500 deductible = 17000 
         
Lifetime Max. 

2,000,000

2,000,000

 2,000,000

2,000,000
         
Pre-Existing Waiting Period
There is a 12 month waiting period for prior medical conditions at the point of effective date here IF you do not have current coverage being replaced by us		 12 Month for prior medical conditions. Waived if you are replacing 12 Month for prior medical conditions. Waived if you are replacing 12 Month for prior medical conditions. Waived if you are replacing 12 Month for prior medical conditions. Waived if you are replacing
         
Prescription Coverage's        
 

$250 Medical Deductible---->

$500 Medical Deductible---->

$1000 Medical Deductible---->
Rx Deductibles Rx Classes Rx
Copayments
$100 Generic
Formulary
Non-Form		 $10
25%
50%
$200 Generic
Formulary
Non-Form		 $10
25%
50%
$400 Generic
Formulary
Non-Form		 $10
25%
50%
Rx Deductibles Rx Classes Rx
Copayments
None Generic
Formulary
Non-Form		 $10
25%
50%
None Generic
Formulary
Non-Form		 $10
25%
50%
None Generic
Formulary
Non-Form		 $10
25%
50%

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
Hospitalization        
Room & Board
Inpatient Physician
Surgeon & Anesthesiologist

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
Maternity        
Outpatient Care
Physician Delivery Fee
Hospital Room & Board 		 $5,000 Deductible. 100% coverage thereafter. Coverage is only effective after the first 12 months of continuous coverage.  No maternity coverage in first 12 months. $5,000 Deductible. 100% coverage thereafter. Coverage is only effective after the first 12 months of continuous coverage.  No maternity coverage in first 12 months. $5,000 Deductible. 100% coverage thereafter.  Coverage is only effective after the first 12 months of continuous coverage.  No maternity coverage in first 12 months. $5,000 Deductible. 100% coverage thereafter.  Coverage is only effective after the first 12 months of continuous coverage.  No maternity coverage in first 12 months.
         
Out-Patient Care         
         
Doctor Office Coverage's:         
Preventative Care-By Primary Doctor
Annual Physical
Immunizations 

$30 copay - No Ded.

No Limit on children

$20 copay - No Ded.

No Limit on children

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
Office Visits - Primary Care
Office Visits - After Hours
Office Visits Specialist
Minor Lab/X-ray w/ mammography

$30 copay - No Ded.
$30 copay - No Ded.
$30 copay - No Ded.
100% No Deductible

$20 copay - No Ded.
$20 copay - No Ded.
$20 copay - No Ded.
100% No Deductible

After meeting your one time calendar year deductible you pay 30% 

After meeting your one time calendar year deductible you pay 20%
         
Major Lab/X-ray w/ CT scan, MRI/MRA  You pay 30% after Ded. You pay 20% after Ded. You pay 30% after Ded. You pay 20% after Ded.
         
Physiotherapy -
Physiotherapy -
Providers Office -
Outpatient Facility		 No max
No max
$30 copay - No Ded.
You pay 20% after Ded.		 No max
No max
$20 copay - No Ded.
You pay 20% after Ded.		 No max
No max
You pay 30% after Ded. 		 No max
No max
You pay 20% after Ded.
         
Out Patient Surgery  You pay 30% after Ded. You pay 20% after Ded. You pay 30% after Ded. You pay 20% after Ded.
         
Outpatient Hospital Services
Chemotherapy, Radiation therapy
Kidney Dialysis		 You pay 30% after Ded. You pay 20% after Ded.  

You pay 30% after Ded. 

 You pay 20% after Ded.
         
Eye Exams - Optometrist  No Coverage No Coverage  No Coverage No Coverage
         
Emergency Care        
         
Emergency Room Visit
In-network Hospital
Out-of-network Hospital
Non - Accidental Visit
Accidental Visit 		 Full Coverage
Full Coverage
Full Coverage
After deductible and $100 Copayment, you pay 30%

Full Coverage
Full Coverage
Full Coverage
After deductible and $75
Copayment, you pay 20%

After meeting your one time calendar year deductible you pay 30% 

After meeting your one time calendar year deductible you pay 20%
         
Urgent Care at Dr. Office
Urgent Care at Facility (Clinic) 		 $30 copay - No Ded.
$30 copay - No Ded.

$20 copay - No Ded.
$20 copay - No Ded.

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
 Ambulance, Paramedics
Air Ambulance		 You pay 30% after Ded.
 		 You pay 20% after Ded.
 		 You pay 30% after Ded.
 		 You pay 20% after Ded.
 
         
Other Benefits         
         
Medical Supplies
Accident-Related Dental Services
Lifetime Max 

You pay 30% after Ded.
You pay 50% after Ded.
$1,000

You pay 20% after Ded.
You pay 50% after Ded.
$1,000

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
Allergy Conditions
Testing & Treatment
Injections 
No Coverage For Test
No Coverage
No Coverage For Test
No Coverage
No Coverage For Test
No Coverage
No Coverage For Test
No Coverage
         
Serum:

Limited Coverage

 Limited Coverage Limited Coverage

Limited Coverage
         
Infertility Treatment -
Limited To:
Yearly Maximum Benefit
Lifetime Maximum Benefit 		 Diagnostic Only

$1,500
$5,000		 Diagnostic Only

$1,500
$5,000		 Diagnostic Only

$1,500
$5,000		 Diagnostic Only

$1,500
$5,000
         
Adoption Benefit Payable to You

$3,155 Per Adoption

$3,155 Per Adoption

$3,155 Per Adoption

$3,155 Per Adoption
         
Chiropractic Care -  

$30 copay - No Ded.

$20 copay - No Ded.

After meeting your one time calendar year deductible you pay 30%

After meeting your one time calendar year deductible you pay 20%
         
Maximum Visits per year 

 $1500 max benefit

$1500 max benefit

$1500 max benefit

$1500 max benefit
         
Mental Health  After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum".

After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum".

After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum".

After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum".
Substance Abuse  After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum". After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum". After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum". After Ded. 50% copay to maximum of $1,500.  Coinsurance does not apply to "out-of-pocket maximum".
 
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